Provider Demographics
NPI:1598729444
Name:MCCOLE, SHANNON MARIE (MD)
Entity Type:Individual
Prefix:DR
First Name:SHANNON
Middle Name:MARIE
Last Name:MCCOLE
Suffix:
Gender:F
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:PO BOX 936
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23501-0936
Mailing Address - Country:US
Mailing Address - Phone:757-627-4512
Mailing Address - Fax:757-461-4538
Practice Address - Street 1:600 GRESHAM DR
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23507-1904
Practice Address - Country:US
Practice Address - Phone:757-461-0050
Practice Address - Fax:757-461-4538
Is Sole Proprietor?:No
Enumeration Date:2006-04-16
Last Update Date:2009-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101056000207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1598729444Medicaid
VA305196OtherANTHEM GRESHAM DR
NC890591LMedicaid
VAPAROtherVA PREMIER HEALTH
VAPAROtherUSA MANAGED CARE
VA4133834OtherUHC/MAMSI
NC0591LOtherNC BC/BS
VAPAROtherCIGNA
VAPAROtherVA HEALTH NETWORK
VAPAROtherFIRST HEALTH COMMERCIAL
VA305195OtherANTHEM FF AVE
VAPAROtherMULTIPLAN
VA60681OtherSHP/OHP
VIPAROtherAETNA
VAPAROtherCORVEL/CORCARE
VAPAROtherTRICARE/CHAMPUS
VAPAROtherVIRGNIA HEALTH NETWORK
VIPAROtherAETNA
VAPAROtherFIRST HEALTH COMMERCIAL