Provider Demographics
NPI:1477539062
Name:COLE, DANIEL J (MD)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:J
Last Name:COLE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3000 STONEWOOD DR
Mailing Address - Street 2:SUITE 200
Mailing Address - City:WEXFORD
Mailing Address - State:PA
Mailing Address - Zip Code:15090-8317
Mailing Address - Country:US
Mailing Address - Phone:724-934-5520
Mailing Address - Fax:724-934-5533
Practice Address - Street 1:3000 STONEWOOD DR
Practice Address - Street 2:SUITE 200
Practice Address - City:WEXFORD
Practice Address - State:PA
Practice Address - Zip Code:15090-8317
Practice Address - Country:US
Practice Address - Phone:724-934-5520
Practice Address - Fax:724-934-5533
Is Sole Proprietor?:No
Enumeration Date:2005-12-16
Last Update Date:2016-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD034701E208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA100306OtherUPMC
PA6648075002OtherCIGNA
PA078251OtherAETNA
PA01201916Medicaid
PA605020OtherHIGHMARK BLUE SHIELD
PA13653OtherELDER HEALTH CARE
PA605020LMCMedicare ID - Type Unspecified
PA01201916Medicaid