Provider Demographics
NPI:1316029911
Name:COLE, TERRILYNE (MD, MBA)
Entity Type:Individual
Prefix:DR
First Name:TERRILYNE
Middle Name:
Last Name:COLE
Suffix:
Gender:F
Credentials:MD, MBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6010 BOND AVE
Mailing Address - Street 2:
Mailing Address - City:CENTREVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62207-2328
Mailing Address - Country:US
Mailing Address - Phone:217-766-2426
Mailing Address - Fax:618-337-3205
Practice Address - Street 1:6010 BOND AVE
Practice Address - Street 2:
Practice Address - City:CENTREVILLE
Practice Address - State:IL
Practice Address - Zip Code:62207-2328
Practice Address - Country:US
Practice Address - Phone:618-337-8153
Practice Address - Fax:618-337-3205
Is Sole Proprietor?:No
Enumeration Date:2006-10-20
Last Update Date:2011-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA43598207R00000X
IL036119274207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine