Individual
DR. MIA M MACCOLLIN
Active
Sole proprietor
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
149 13TH ST, 6TH FLOOR CYN 149 6, CHARLESTOWN, MA 02129-2020
(617) 726-7856
(617) 724-9620
Mailing address
PO BOX 9142, CHARLESTOWN, MA 02129-9142
(617) 724-0287
(617) 726-2894
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
73495
MA
2084N0402X
Neurology with Special Qualifications in Child Neurology Physician
73495
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3131360
—
MA
01
—
727826
TUFTS HEALTH PLAN
MA
01
—
J30964
BCBS MA
MA
Enumeration date
10/25/2005
Last updated
09/11/2025
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