MEDICARE: DR. CHARLES L COLE JR. MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207X00000X	Orthopaedic Surgery Physician	MD042147E	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1023012861
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CHARLES L COLE JR. MD

Provider Business Mailing Address
First Line	:	1 HOSPITAL DR STE 306
Second Line	:
City	:	LEWISBURG
State	:	PA
Zip	:	17837-9350
Country	:	US
Telephone Number	:	570-522-4110
Fax Number	:	570-768-3911

Provider Business Practice Location Address
First Line	:	210 JPM RD STE 300
Second Line	:
City	:	LEWISBURG
State	:	PA
Zip	:	17837-9367
Country	:	US
Telephone Number	:	570-524-4446
Fax Number	:	570-768-4623

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/09/2005
Last Update Date	:	06/08/2022

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