Provider Demographics
NPI:1558336321
Name:COLE, BRENT K (MD)
Entity Type:Individual
Prefix:DR
First Name:BRENT
Middle Name:K
Last Name:COLE
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:19735 GERMANTOWN RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:GERMANTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:20874-1214
Mailing Address - Country:US
Mailing Address - Phone:301-493-4440
Mailing Address - Fax:301-917-6501
Practice Address - Street 1:10215 FERNWOOD RD STE 100
Practice Address - Street 2:
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20817-1183
Practice Address - Country:US
Practice Address - Phone:301-493-4440
Practice Address - Fax:301-493-9778
Is Sole Proprietor?:No
Enumeration Date:2006-02-23
Last Update Date:2019-05-03
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MDD0060129207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
DCH33667Medicare UPIN
DCG01234Medicare ID - Type Unspecified