Healthcare Provider Details

I. General information

NPI: 1669623195
Provider Name (Legal Business Name): DANIEL COLE PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/02/2008
Last Update Date: 10/02/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3 ALBERT CREE DR
RUTLAND VT
05701-4601
US

IV. Provider business mailing address

3 ALBERT CREE DR
RUTLAND VT
05701-4601
US

V. Phone/Fax

Practice location:
  • Phone: 802-775-2937
  • Fax: 802-773-0934
Mailing address:
  • Phone: 802-775-2937
  • Fax: 802-773-0934

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number0550030934
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: