Colonial Medical Practice

Primary specialty

Child & Adolescent Psychiatry PhysicianTaxonomy code 2084P0804X

License

ME101147 Issued in FL

Legal business name

COLONIAL MEDICAL PRACTICE

Practice address

227 Salvador SQ
Winter Park, FL 32789-5618

Phone

(407) 427-1855

Fax

(407) 427-1844

NPI assigned

Feb 19, 2010

Last updated

Jan 18, 2024By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Robert Gutman

Title

President

Phone

(407) 427-1855

Specialties & licenses 1

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1266537600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1705536000000",
    "number": "1518289487",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "227 SALVADOR SQ",
            "city": "WINTER PARK",
            "state": "FL",
            "postal_code": "327895618",
            "telephone_number": "407-427-1855",
            "fax_number": "407-427-1844"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "227 SALVADOR SQ",
            "city": "WINTER PARK",
            "state": "FL",
            "postal_code": "327895618",
            "telephone_number": "407-427-1855",
            "fax_number": "407-427-1844"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COLONIAL MEDICAL PRACTICE",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-02-19",
        "last_updated": "2024-01-18",
        "certification_date": "2024-01-18",
        "status": "A",
        "authorized_official_last_name": "GUTMAN",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "407-427-1855"
    },
    "taxonomies": [
        {
            "code": "2084P0804X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychiatry & Neurology, Child & Adolescent Psychiatry",
            "state": "FL",
            "license": "ME101147",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Child & Adolescent Psychiatry Physician in Winter Park, FL
• Providers in Winter Park, FL by specialty
• Child & Adolescent Psychiatry Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 18, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.