Basic Information
| Provider Information | |||||||||
| NPI: | 1154301950 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MCCAUL | ||||||||
| FirstName: | COLIN | ||||||||
| MiddleName: | P | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 301 SCIENCE PARK RD | ||||||||
| Address2: | SUITE 207 | ||||||||
| City: | STATE COLLEGE | ||||||||
| State: | PA | ||||||||
| PostalCode: | 168032293 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8142725805 | ||||||||
| FaxNumber: | 8142720110 | ||||||||
| Practice Location | |||||||||
| Address1: | 301 SCIENCE PARK RD | ||||||||
| Address2: | SUITE 207 | ||||||||
| City: | STATE COLLEGE | ||||||||
| State: | PA | ||||||||
| PostalCode: | 168032293 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8142725805 | ||||||||
| FaxNumber: | 8142720110 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/18/2006 | ||||||||
| LastUpdateDate: | 03/02/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 03/02/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208100000X | MD428049 | PA | Y | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation |
ID Information
| ID | Type | State | Issuer | Description | 1016152280001 | 05 | PA | MEDICAID | 097686 | 01 | PA | MEDICARE LEGACY GROUP# | OTHER | CI7521 | 01 | PA | RAILROAD MEDICARE GRP# | OTHER | 50062055 | 01 | PA | CAPITAL BCBS# | OTHER | 1873055 | 01 | PA | HIGHMARK# | OTHER | P00409316 | 01 | PA | RAILROAD MEDICARE INDIV# | OTHER |