Provider Demographics
NPI:1043201502
Name:COLE, ANDREW JAMES (MD)
Entity Type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:JAMES
Last Name:COLE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 9142
Mailing Address - Street 2:
Mailing Address - City:CHARLESTOWN
Mailing Address - State:MA
Mailing Address - Zip Code:02129-9142
Mailing Address - Country:US
Mailing Address - Phone:617-726-3311
Mailing Address - Fax:617-726-9250
Practice Address - Street 1:55 FRUIT ST
Practice Address - Street 2:VBK 830
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02114-2621
Practice Address - Country:US
Practice Address - Phone:617-726-3311
Practice Address - Fax:617-726-9250
Is Sole Proprietor?:No
Enumeration Date:2005-11-03
Last Update Date:2012-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA763602084N0400X, 2084N0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No2084N0600XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyClinical Neurophysiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAJ12895OtherBCBS MA
MA076360OtherTUFTS HEALTH PLAN
MA3096769Medicaid
MA076360OtherTUFTS HEALTH PLAN
MA3096769Medicaid