Healthcare Provider Details

I. General information

NPI: 1831188697
Provider Name (Legal Business Name): JUDITH M. MCCOLE DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/14/2005
Last Update Date: 06/18/2020
Certification Date: 06/18/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15 CONSTITUTION DR ELLIOT FAMILY MEDICINE AT BEDFORD VILLAGE
BEDFORD NH
03110-6042
US

IV. Provider business mailing address

15 CONSTITUTION DR ELLIOT FAMILY MEDICINE AT BEDFORD VILLAGE
BEDFORD NH
03110-6042
US

V. Phone/Fax

Practice location:
  • Phone: 603-472-7233
  • Fax: 603-472-9188
Mailing address:
  • Phone: 603-472-7233
  • Fax: 603-472-9188

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number9842
License Number StateNH
# 2
Primary TaxonomyN
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License Number9842
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: