Individual
JACK A. COLLAZZO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
825 OLD LANCASTER RD, SUITE 320, BRYN MAWR, PA 19010-3231
(610) 527-3800
(610) 527-8805
Mailing address
825 OLD LANCASTER RD, SUITE 320, BRYN MAWR, PA 19010-3231
(610) 527-3800
(610) 527-0334
Taxonomy
Speciality
Code
Description
License number
State
207RG0100X
Gastroenterology Physician
Primary
MD052149-L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0015849150005
—
PA
Enumeration date
07/04/2006
Last updated
04/05/2017
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