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General NPI Number Information
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NPI Number | 1295315794
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Entity Type | Individual
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Provider Name | CEDRIC COLE MD
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Gender | Male
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Dates
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Enumeration Date | 04/09/2021
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Last Update Date | 07/24/2025
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Provider Practice Location Address
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Address Line | 620 JOHN PAUL JONES CIR
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City | PORTSMOUTH
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State | VA
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Zip | 23708-2111
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Country | US
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Telephone | 757-836-5929
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Fax |
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Provider Business Mailing Address
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Address Line | 323 MOBILE ST
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City | LOUISVILLE
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State | MS
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Zip | 39339-3219
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Country | US
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Telephone |
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Fax |
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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 | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 01094266A
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License Number State | IN
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 0101284135
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License Number State | VA
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