Basic Information
| Provider Information | |||||||||
| NPI: | 1255305074 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | COLAN | ||||||||
| FirstName: | STEVEN | ||||||||
| MiddleName: | DONALD | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 845628 | ||||||||
| Address2: | |||||||||
| City: | BOSTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 022845628 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6038939784 | ||||||||
| FaxNumber: | 6038938886 | ||||||||
| Practice Location | |||||||||
| Address1: | 300 LONGWOOD AVE | ||||||||
| Address2: | |||||||||
| City: | BOSTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 021155724 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6173556793 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/16/2006 | ||||||||
| LastUpdateDate: | 12/10/2012 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | 45128 | MA | N | Allopathic & Osteopathic Physicians | Pediatrics | 2080P0202X | 45128 | MA | Y | Allopathic & Osteopathic Physicians | Pediatrics | Pediatric Cardiology |
ID Information
| ID | Type | State | Issuer | Description | 30001169 | 05 | NH | MEDICAID | 7500121 | 01 | MA | UNITED HEALTHCARE MA | OTHER | 1098719 | 05 | NY | MEDICAID | 003054392 | 05 | CT | MEDICAID | 7610392 | 05 | NC | MEDICAID | SC03665 | 05 | RI | MEDICAID | 99254901 | 01 | MA | NETWORK HEALTH | OTHER | AA9210 | 01 | MA | HARVARD PILGRIM | OTHER | B20086501 | 01 | MA | CIGNA MA | OTHER | E05286 | 01 | MA | BCBS MA | OTHER |