Healthcare Provider Details

I. General information

NPI: 1891713699
Provider Name (Legal Business Name): TARA J COLE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/18/2006
Last Update Date: 04/19/2021
Certification Date: 04/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 E WENDOVER AVE SUITE 300
GREENSBORO NC
27401-1230
US

IV. Provider business mailing address

PO BOX 14883
GREENSBORO NC
27415-4883
US

V. Phone/Fax

Practice location:
  • Phone: 336-268-3380
  • Fax: 336-268-3381
Mailing address:
  • Phone: 336-268-3380
  • Fax: 336-268-3381

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number200600807
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: