1508850660 NPI number — KATHERINE JOYCE COLE MD

Table of content: KATHERINE JOYCE COLE MD (NPI 1508850660)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1508850660 NPI number — KATHERINE JOYCE COLE MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
COLE
Provider First Name:
KATHERINE
Provider Middle Name:
JOYCE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1508850660
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/22/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 791128
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BALTIMORE
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21279-1128
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
703-391-2020
Provider Business Mailing Address Fax Number:
703-391-1211

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3650 JOSEPH SIEWICK DR
Provider Second Line Business Practice Location Address:
STE 400
Provider Business Practice Location Address City Name:
FAIRFAX
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
22033-1710
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
703-391-2020
Provider Business Practice Location Address Fax Number:
703-391-1211
Provider Enumeration Date:
09/06/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  0101041443 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 080182892 . This is a "RR MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 05602556 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".




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