Active NPI
Colleen Davis, P.A.
- Surgical Physician Assistant
- Wilmington, DE
National Provider Identifier
1922109206
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Surgical Physician Assistant
- License
- C50000438
- Practice address
- 1306 N Broom St
Wilmington, DE 19806-4209 - Phone
- (302) 571-9750
- Fax
- (302) 571-0620
- NPI assigned
- Sep 26, 2006
- 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 |
|---|---|---|---|---|
| Surgical Physician Assistant | 363AS0400X | C50000438 | DE | Primary |
| Surgical Physician Assistant | 363AS0400X | C03083 | MD |
Addresses
Primary practice location
1306 N Broom St
Wilmington, DE 19806-4209
Mailing address
1306 N Broom St
Wilmington, DE 19806-4209
Phone (302) 571-9750
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 016022N04 | Other | DE | RAILROAD MEDICARE |
| C50000438 | Other | DE | DE LICENSE |
| C03083 | Other | MD | MD STATE LICENSE |
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
- Physician Assistant
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Christiana Spine Ambulatory Surgical Center, LLC | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Ambulatory Surgical Clinic/Center
- Newark, DE
- NPI 1275774747
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1159228800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1217980800000",
"number": "1922109206",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1306 N BROOM ST",
"city": "WILMINGTON",
"state": "DE",
"postal_code": "198064209",
"telephone_number": "302-571-9750",
"fax_number": "302-571-0620"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1306 N BROOM ST",
"city": "WILMINGTON",
"state": "DE",
"postal_code": "198064209",
"telephone_number": "302-571-9750",
"fax_number": "302-571-0620"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DAVIS",
"first_name": "COLLEEN",
"credential": "P.A.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-09-26",
"last_updated": "2008-08-06",
"status": "A"
},
"taxonomies": [
{
"code": "363AS0400X",
"taxonomy_group": "",
"desc": "Physician Assistant, Surgical",
"state": "DE",
"license": "C50000438",
"primary": true
},
{
"code": "363AS0400X",
"taxonomy_group": "",
"desc": "Physician Assistant, Surgical",
"state": "MD",
"license": "C03083",
"primary": false
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RAILROAD MEDICARE",
"identifier": "016022N04",
"state": "DE"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "DE LICENSE",
"identifier": "C50000438",
"state": "DE"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MD STATE LICENSE",
"identifier": "C03083",
"state": "MD"
}
],
"endpoints": [],
"other_names": []
}Other providers in Wilmington, DE
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 6, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.