Provider Demographics
NPI:1184678955
Name:COLE, BRIAN G (MD, MPH)
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:G
Last Name:COLE
Suffix:
Gender:M
Credentials:MD, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4133 MEDICAL CENTER DR
Mailing Address - Street 2:
Mailing Address - City:BROAD TOP
Mailing Address - State:PA
Mailing Address - Zip Code:16621-9001
Mailing Address - Country:US
Mailing Address - Phone:814-635-2916
Mailing Address - Fax:814-635-2918
Practice Address - Street 1:4133 MEDICAL CENTER DR
Practice Address - Street 2:
Practice Address - City:BROAD TOP
Practice Address - State:PA
Practice Address - Zip Code:16621-9001
Practice Address - Country:US
Practice Address - Phone:814-635-2916
Practice Address - Fax:814-635-2918
Is Sole Proprietor?:No
Enumeration Date:2006-05-19
Last Update Date:2014-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA223347207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAH27331Medicare UPIN