Healthcare Provider Details

I. General information

NPI: 1043201502
Provider Name (Legal Business Name): ANDREW JAMES COLE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/03/2005
Last Update Date: 05/08/2025
Certification Date: 05/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

55 FRUIT ST VBK 830
BOSTON MA
02114-2621
US

IV. Provider business mailing address

PO BOX 9142
CHARLESTOWN MA
02129-9142
US

V. Phone/Fax

Practice location:
  • Phone: 617-726-3311
  • Fax: 617-726-9250
Mailing address:
  • Phone: 617-726-3311
  • Fax: 617-726-9250

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number76360
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code2084N0600X
TaxonomyClinical Neurophysiology Physician
License Number76360
License Number StateMA
# 3
Primary TaxonomyY
Taxonomy Code2084E0001X
TaxonomyEpilepsy Physician
License Number76360
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: