Provider Demographics
NPI:1790881860
Name:COLE, LINDA S
Entity Type:Individual
Prefix:DR
First Name:LINDA
Middle Name:S
Last Name:COLE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:LINDA
Other - Middle Name:S
Other - Last Name:COLE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:139 W MAPLE ST
Mailing Address - Street 2:
Mailing Address - City:GRANVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43023-1138
Mailing Address - Country:US
Mailing Address - Phone:740-587-7473
Mailing Address - Fax:740-587-7473
Practice Address - Street 1:139 W MAPLE ST
Practice Address - Street 2:
Practice Address - City:GRANVILLE
Practice Address - State:OH
Practice Address - Zip Code:43023-1138
Practice Address - Country:US
Practice Address - Phone:740-587-7473
Practice Address - Fax:740-587-7473
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-16
Last Update Date:2011-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH53008208D00000X, 2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice