Provider Demographics
NPI:1205232485
Name:COLE, ANTONIO DEON
Entity Type:Individual
Prefix:
First Name:ANTONIO
Middle Name:DEON
Last Name:COLE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4807 KING JOHN WAY
Mailing Address - Street 2:
Mailing Address - City:UPPER MARLBORO
Mailing Address - State:MD
Mailing Address - Zip Code:20772-5983
Mailing Address - Country:US
Mailing Address - Phone:954-817-3054
Mailing Address - Fax:
Practice Address - Street 1:1790 SATURN ST
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70129-2270
Practice Address - Country:US
Practice Address - Phone:504-253-4677
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-11-14
Last Update Date:2014-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman