Provider Demographics
NPI:1053517169
Name:DR. EDWARD S KOLE DO PC
Entity type:Organization
Organization Name:DR. EDWARD S KOLE DO PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:KOLE
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:215-354-1010
Mailing Address - Street 1:1003 STREET RD
Mailing Address - Street 2:
Mailing Address - City:SOUTHAMPTON
Mailing Address - State:PA
Mailing Address - Zip Code:18966-4230
Mailing Address - Country:US
Mailing Address - Phone:215-354-1010
Mailing Address - Fax:215-354-1099
Practice Address - Street 1:1003 STREET RD
Practice Address - Street 2:
Practice Address - City:SOUTHAMPTON
Practice Address - State:PA
Practice Address - Zip Code:18966-4230
Practice Address - Country:US
Practice Address - Phone:215-354-1010
Practice Address - Fax:215-354-1099
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-25
Last Update Date:2007-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS 009149-L208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty