Healthcare Provider Details

I. General information

NPI: 1790132199
Provider Name (Legal Business Name): JUSTIN ALLEN COLE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/16/2016
Last Update Date: 01/09/2023
Certification Date: 01/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10421 SCARLET OAK DR
PERRYSBURG OH
43551
US

IV. Provider business mailing address

10421 SCARLET OAK DR
PERRYSBURG OH
43551-9169
US

V. Phone/Fax

Practice location:
  • Phone: 724-557-0327
  • Fax:
Mailing address:
  • Phone: 724-557-0327
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number35.134694
License Number StateOH
# 3
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberMD469018
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: