Healthcare Provider Details

I. General information

NPI: 1518076561
Provider Name (Legal Business Name): FREDERICK L COLE DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/30/2006
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 SECLUDED LN
RIO GRANDE NJ
08242-1546
US

IV. Provider business mailing address

4 EVES DR # A SUITE 100
MARLTON NJ
08053-3195
US

V. Phone/Fax

Practice location:
  • Phone: 609-868-0710
  • Fax: 609-886-8862
Mailing address:
  • Phone: 609-267-9400
  • Fax: 609-267-9457

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberMB24077
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: