Healthcare Provider Details

I. General information

NPI: 1851435184
Provider Name (Legal Business Name): JENNIFER E COLES M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/19/2007
Last Update Date: 02/10/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1514 N 2ND ST
HARRISBURG PA
17102-2505
US

IV. Provider business mailing address

PO BOX 813
TREXLERTOWN PA
18087-0813
US

V. Phone/Fax

Practice location:
  • Phone: 610-481-0481
  • Fax: 610-481-0486
Mailing address:
  • Phone: 610-481-0481
  • Fax: 610-481-0486

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberP17480
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: