MEDICARE: DR. JUSTIN ANDREW COLES 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	207R00000X	Internal Medicine Physician	0101287181	VA
2	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1336767391
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JUSTIN ANDREW COLES MD

Provider Business Mailing Address
First Line	:	33 REBECCA DR
Second Line	:
City	:	PALMYRA
State	:	VA
Zip	:	22963-6242
Country	:	US
Telephone Number	:	434-654-4680
Fax Number	:

Provider Business Practice Location Address
First Line	:	33 REBECCA DR
Second Line	:
City	:	PALMYRA
State	:	VA
Zip	:	22963-6242
Country	:	US
Telephone Number	:	434-654-4680
Fax Number	:

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

Provider Enumeration Date	:	07/07/2020
Last Update Date	:	09/12/2025

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