Provider Demographics
NPI:1437120748
Name:COLDREN, CAROL L (MD)
Entity Type:Individual
Prefix:DR
First Name:CAROL
Middle Name:L
Last Name:COLDREN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:495 THOMAS JONES WAY
Mailing Address - Street 2:SUITE 210 MAIN LINE HEALTH CENTER
Mailing Address - City:EXTON
Mailing Address - State:PA
Mailing Address - Zip Code:19341-2553
Mailing Address - Country:US
Mailing Address - Phone:484-565-8550
Mailing Address - Fax:610-280-1569
Practice Address - Street 1:495 THOMAS JONES WAY
Practice Address - Street 2:SUITE 210 MAIN LINE HEALTH CENTER
Practice Address - City:EXTON
Practice Address - State:PA
Practice Address - Zip Code:19341-2553
Practice Address - Country:US
Practice Address - Phone:484-565-8550
Practice Address - Fax:610-280-1569
Is Sole Proprietor?:No
Enumeration Date:2006-01-27
Last Update Date:2011-10-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAMD041974L207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA232359401OtherMAIN LINE HEALTHCARE
PA001279605Medicaid
PA001279605Medicaid
PA232359401OtherMAIN LINE HEALTHCARE