Healthcare Provider Details

I. General information

NPI: 1831151950
Provider Name (Legal Business Name): ENSER W COLE III MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/04/2006
Last Update Date: 04/26/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 CATON AVE
BALTIMORE MD
21229
US

IV. Provider business mailing address

900 CATON AVE
BALTIMORE MD
21229-5201
US

V. Phone/Fax

Practice location:
  • Phone: 667-234-3416
  • Fax: 667-234-3517
Mailing address:
  • Phone: 667-234-3414
  • Fax: 667-234-3517

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License NumberD0016354
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: