Provider Demographics
NPI:1497050892
Name:COLES, KEVIN RODNEY (CSA)
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:RODNEY
Last Name:COLES
Suffix:
Gender:M
Credentials:CSA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14330 COLONEL CLAGETT CT
Mailing Address - Street 2:
Mailing Address - City:UPPER MARLBORO
Mailing Address - State:MD
Mailing Address - Zip Code:20772-2900
Mailing Address - Country:US
Mailing Address - Phone:760-731-0313
Mailing Address - Fax:760-731-0414
Practice Address - Street 1:14330 COLONEL CLAGETT CT
Practice Address - Street 2:
Practice Address - City:UPPER MARLBORO
Practice Address - State:MD
Practice Address - Zip Code:20772-2900
Practice Address - Country:US
Practice Address - Phone:760-731-0313
Practice Address - Fax:760-731-0414
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-14
Last Update Date:2011-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD246ZS0410X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZS0410XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Technologist