Provider Demographics
NPI:1366598898
Name:COLACO, ANDRE S (MD)
Entity type:Individual
Prefix:
First Name:ANDRE
Middle Name:S
Last Name:COLACO
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:116 DEFENSE HWY
Mailing Address - Street 2:STE 400
Mailing Address - City:ANNAPOLIS
Mailing Address - State:MD
Mailing Address - Zip Code:21401-7050
Mailing Address - Country:US
Mailing Address - Phone:410-897-9841
Mailing Address - Fax:410-897-9852
Practice Address - Street 1:116 DEFENSE HWY STE 400
Practice Address - Street 2:
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21401
Practice Address - Country:US
Practice Address - Phone:410-897-9841
Practice Address - Fax:410-897-9852
Is Sole Proprietor?:No
Enumeration Date:2007-01-26
Last Update Date:2018-08-22
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MDD0067263207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
039732900OtherFEDERAL BLACK LUNG
145724700OtherFEDERAL WORKMAN'S COMP DEPT OF LABOR
MD4157249Medicaid
S3990051OtherCAREFIRST DC
1917064OtherAETNA HMO
9269182OtherAETNA PPO
277001OtherKAISER PERMANENTE
219448OtherJOHNS HOPKINS HEALTHCARE
KJ77AN9398801OtherCAREFIRST MARYLAND
145724700OtherFEDERAL WORKMAN'S COMP DEPT OF LABOR
MD4157249Medicaid
277001OtherKAISER PERMANENTE
S3990051OtherCAREFIRST DC