Active NPI
Mia M Maccollin, MD
- Pediatrics Physician
- Charlestown, MA
National Provider Identifier
1437149093
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatrics Physician
- License
- 73495
- Practice address
- 149 13TH St
6TH Floor Cyn 149 6
Charlestown, MA 02129-2020 - Phone
- (617) 726-7856
- Fax
- (617) 724-9620
- NPI assigned
- Oct 25, 2005
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | 73495 | MA | Primary |
| Neurology with Special Qualifications in Child Neurology Physician | 2084N0402X | 73495 | MA |
Addresses
Primary practice location
149 13TH St
6TH Floor Cyn 149 6
Charlestown, MA 02129-2020
Mailing address
PO Box 9142
Charlestown, MA 02129-9142
Phone (617) 724-0287
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 727826 | Other | MA | TUFTS HEALTH PLAN |
| J30964 | Other | MA | BCBS MA |
| 3131360 | Medicaid | MA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 73495 | MA | MD | Neurology with Special Qualifications in Child Neurology Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1130198400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1783900800000",
"number": "1437149093",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 9142",
"city": "CHARLESTOWN",
"state": "MA",
"postal_code": "021299142",
"telephone_number": "617-724-0287",
"fax_number": "617-726-2894"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "149 13TH ST",
"address_2": "6TH FLOOR CYN 149 6",
"city": "CHARLESTOWN",
"state": "MA",
"postal_code": "021292020",
"telephone_number": "617-726-7856",
"fax_number": "617-724-9620"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MACCOLLIN",
"first_name": "MIA",
"middle_name": "M",
"name_prefix": "Dr.",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2005-10-25",
"last_updated": "2026-07-13",
"status": "A"
},
"taxonomies": [
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "MA",
"license": "73495",
"primary": true
},
{
"code": "2084N0402X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Neurology with Special Qualifications in Child Neurology",
"state": "MA",
"license": "73495",
"primary": false
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "TUFTS HEALTH PLAN",
"identifier": "727826",
"state": "MA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS MA",
"identifier": "J30964",
"state": "MA"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "3131360",
"state": "MA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Charlestown, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 13, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.