Healthcare Provider Details

I. General information

NPI: 1457397168
Provider Name (Legal Business Name): MARK CHRISTOPHER COLES N.P.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 MEMORIAL DR
LURAY VA
22835-1000
US

IV. Provider business mailing address

2365 KERR DR
VIRGINIA BEACH VA
23454-6564
US

V. Phone/Fax

Practice location:
  • Phone: 540-743-4561
  • Fax:
Mailing address:
  • Phone: 757-426-5439
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number0017137066
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: