Provider Demographics
NPI:1578551263
Name:COLEY, ANDREW DOUGLAS (MD)
Entity Type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:DOUGLAS
Last Name:COLEY
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 1:235 W 6TH ST
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89503-4548
Mailing Address - Country:US
Mailing Address - Phone:401-300-9911
Mailing Address - Fax:775-746-1904
Practice Address - Street 1:235 W 6TH ST
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89503-4548
Practice Address - Country:US
Practice Address - Phone:401-300-9911
Practice Address - Fax:775-746-1904
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-07
Last Update Date:2009-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RI09890207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
RIG92160Medicare UPIN