Basic Information
Provider Information
NPI: 1558422907
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: COLLINS
FirstName: TAMI
MiddleName: RENEE
NamePrefix: DR.
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 2101 E JEFFERSON ST
Address2: KAISER PERMANENTE MEDICARE ENROLLMENT
City: ROCKVILLE
State: MD
PostalCode: 208524908
CountryCode: US
TelephoneNumber: 3018166660
FaxNumber: 3018166308
Practice Location
Address1: 6104 OLD BRANCH AVE
Address2: KAISER PERMANENTE CAMP SPRINGS MEDICAL CENTER
City: TEMPLE HILLS
State: MD
PostalCode: 207482518
CountryCode: US
TelephoneNumber: 3017026100
FaxNumber: 3017026366
Other Information
ProviderEnumerationDate: 12/12/2006
LastUpdateDate: 02/08/2022
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 02/08/2022

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
208000000X0101249788VAN Allopathic & Osteopathic PhysiciansPediatrics 
208000000XMD30788DCN Allopathic & Osteopathic PhysiciansPediatrics 
208000000XD0051701MDY Allopathic & Osteopathic PhysiciansPediatrics 

No ID Information.


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