Provider Demographics
NPI:1811004468
Name:COLE, JOHN WALDEN (MD)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:WALDEN
Last Name:COLE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:16 S EUTAW ST
Mailing Address - Street 2:FRENKIL BLDG. 3RD FL.
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21201-1606
Mailing Address - Country:US
Mailing Address - Phone:410-328-4323
Mailing Address - Fax:410-328-1149
Practice Address - Street 1:16 S EUTAW ST
Practice Address - Street 2:FRENKIL BLDG. 3RD FL.
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21201-1606
Practice Address - Country:US
Practice Address - Phone:410-328-4323
Practice Address - Fax:410-328-1149
Is Sole Proprietor?:No
Enumeration Date:2006-08-23
Last Update Date:2010-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDDOO59159174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDH68966Medicare UPIN