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General NPI Number Information
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NPI Number | 1063694966
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Entity Type | Individual
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Provider Name | THEODORE J COLE DO
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Gender | Male
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Dates
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Enumeration Date | 12/03/2007
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Last Update Date | 01/03/2012
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Provider Practice Location Address
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Address Line | 7760 UNIVERSITY CT SUITE C
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City | WEST CHESTER
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State | OH
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Zip | 45069-3371
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Country | US
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Telephone | 513-563-4321
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Fax | 513-847-1017
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Provider Business Mailing Address
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Address Line | 7760 UNIVERSITY CT SUITE C
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City | WEST CHESTER
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State | OH
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Zip | 45069-3371
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Country | US
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Telephone | 513-563-4321
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Fax | 513-847-1017
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 34004375C
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License Number State | OH
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