Provider Demographics
NPI:1972500668
Name:COLE, RICHARD CLAUDE (MD)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:CLAUDE
Last Name:COLE
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:PO BOX 1019
Mailing Address - Street 2:
Mailing Address - City:STUART
Mailing Address - State:VA
Mailing Address - Zip Code:24171-1019
Mailing Address - Country:US
Mailing Address - Phone:276-694-4466
Mailing Address - Fax:276-694-2909
Practice Address - Street 1:18877 JEB STUART HWY
Practice Address - Street 2:
Practice Address - City:STUART
Practice Address - State:VA
Practice Address - Zip Code:24171-1019
Practice Address - Country:US
Practice Address - Phone:276-694-4466
Practice Address - Fax:276-694-2909
Is Sole Proprietor?:No
Enumeration Date:2005-07-07
Last Update Date:2023-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101036915207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA097030OtherANTHEM BCBS
VA005657342Medicaid
VA005657342Medicaid
VA080003005Medicare ID - Type Unspecified