Provider Demographics
NPI:1497882484
Name:STATEN, COLE D (CSFA)
Entity Type:Individual
Prefix:
First Name:COLE
Middle Name:D
Last Name:STATEN
Suffix:
Gender:M
Credentials:CSFA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:55 STONESTHROW CT
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:OH
Mailing Address - Zip Code:43001-8779
Mailing Address - Country:US
Mailing Address - Phone:614-402-1869
Mailing Address - Fax:888-329-6432
Practice Address - Street 1:55 STONESTHROW CT
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:OH
Practice Address - Zip Code:43001-8779
Practice Address - Country:US
Practice Address - Phone:614-402-1869
Practice Address - Fax:888-329-6432
Is Sole Proprietor?:No
Enumeration Date:2007-02-27
Last Update Date:2019-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
85751OtherCSFA CERT#