Provider Demographics
NPI:1518994789
Name:COLE, RICHARD M (DO)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:M
Last Name:COLE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:1800 LIVINGSTON AVE
Mailing Address - Street 2:
Mailing Address - City:LORAIN
Mailing Address - State:OH
Mailing Address - Zip Code:44052-3781
Mailing Address - Country:US
Mailing Address - Phone:440-240-1655
Mailing Address - Fax:440-245-1218
Practice Address - Street 1:3745 GROVE AVE
Practice Address - Street 2:
Practice Address - City:LORAIN
Practice Address - State:OH
Practice Address - Zip Code:44055-2734
Practice Address - Country:US
Practice Address - Phone:440-240-1655
Practice Address - Fax:440-240-1663
Is Sole Proprietor?:No
Enumeration Date:2006-06-26
Last Update Date:2010-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34-004082207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0631016Medicaid
OHE00717Medicare UPIN
OH4154174Medicare PIN