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General NPI Number Information
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NPI Number | 1598729444
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Entity Type | Individual
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Provider Name | SHANNON MARIE MCCOLE M.D.
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Gender | Female
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Dates
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Enumeration Date | 04/16/2006
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Last Update Date | 01/27/2009
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Provider Practice Location Address
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Address Line | 600 GRESHAM DR
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City | NORFOLK
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State | VA
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Zip | 23507-1904
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Country | US
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Telephone | 757-461-0050
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Fax | 757-461-4538
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Provider Business Mailing Address
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Address Line | PO BOX 936
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City | NORFOLK
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State | VA
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Zip | 23501-0936
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Country | US
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Telephone | 757-627-4512
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Fax | 757-461-4538
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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 | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | 0101056000
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License Number State | VA
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