Provider Demographics
NPI:1124190970
Name:COLE, SOPHIE W (MD)
Entity Type:Individual
Prefix:
First Name:SOPHIE
Middle Name:W
Last Name:COLE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:SOPHIE
Other - Middle Name:WINEFRED
Other - Last Name:COLE-FOSTER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:329 PRIMROSE RD
Mailing Address - Street 2:
Mailing Address - City:BURLINGAME
Mailing Address - State:CA
Mailing Address - Zip Code:94010-4037
Mailing Address - Country:US
Mailing Address - Phone:650-288-1200
Mailing Address - Fax:650-288-4180
Practice Address - Street 1:329 PRIMROSE RD
Practice Address - Street 2:
Practice Address - City:BURLINGAME
Practice Address - State:CA
Practice Address - Zip Code:94010-4037
Practice Address - Country:US
Practice Address - Phone:650-288-1200
Practice Address - Fax:650-288-4180
Is Sole Proprietor?:No
Enumeration Date:2006-11-15
Last Update Date:2014-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG63103207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G631030Medicaid
00G631030Medicare ID - Type Unspecified
F26867Medicare UPIN