Corey B Colla, MD

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

G40722 Issued in CA

Practice address

918 S Fairmont Ave
Lodi, CA 95240-5119

Phone

(209) 366-2001

NPI assigned

May 1, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

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

{
    "created_epoch": "1146441600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1463616000000",
    "number": "1619934809",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "600 COFFEE RD",
            "city": "MODESTO",
            "state": "CA",
            "postal_code": "953554201",
            "telephone_number": "209-521-6097"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "918 S FAIRMONT AVE",
            "city": "LODI",
            "state": "CA",
            "postal_code": "952405119",
            "telephone_number": "209-366-2001"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "COLLA",
        "first_name": "COREY",
        "middle_name": "B",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-01",
        "last_updated": "2016-05-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "CA",
            "license": "G40722",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00G407220",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Maureen Clemons, OTD
• Clinic Services of California Medical Group Inc
• Pamela Allane Colby, N.D.
• Christian B Cole
• Eddie Coleman
• Elizabeth A Collins, RN
• Sean Martin Collins, D.D.S., M.S.D
• Communication Blooms Speech Therapy Inc.
• Community Medical Centers Inc
• Community Medical Centers Inc

• Internal Medicine Physician in Lodi, CA
• Providers in Lodi, CA by specialty
• Internal Medicine Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 19, 2016; 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.