Provider Demographics
NPI:1457324238
Name:COLE, MICHAEL WARD (DO)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:WARD
Last Name:COLE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 936
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23501-0936
Mailing Address - Country:US
Mailing Address - Phone:757-446-8999
Mailing Address - Fax:757-446-7922
Practice Address - Street 1:825 FAIRFAX AVE
Practice Address - Street 2:SUITE 545
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23507-1914
Practice Address - Country:US
Practice Address - Phone:757-446-8999
Practice Address - Fax:757-446-7922
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-10
Last Update Date:2009-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0102036945207RI0200X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA-032OtherCHAMPUS/TRICARE
VAPAROtherVIRGINIA HEALTH NETWORK
NC066T3OtherBC/BS NC
VAPAROtherMULTIPLAN
VAPAROtherFIRST HEALTH COMMERCIAL/SOUTHERN HEALTH/COVENTRY
VAPAROtherUSA MANAGED CARE
VA246126OtherANTHEM BC/BS VA/HK
VA64308OtherSENTARA OHP/SHP
VA64309OtherSENTARA/OPTIMA ID PCP
NC89066T3Medicaid
VAPAROtherCORVEL CORCARE
VAPAROtherAETNA
VA005645191Medicaid
VAPAROtherVIRGINIA PREMIER HEALTH
VAPAROtherAMERICAS HEALTH PLAN
VA295619OtherUHC/MAMSI/MDIPA
VAPAROtherMID-ATLANTIC VICARE
VAPAROtherCIGNA
NC89066T3Medicaid
NC066T3OtherBC/BS NC
VAF13422Medicare UPIN