Provider Demographics
NPI:1396730289
Name:COLE, MARCIA MEGAN (PA-C)
Entity type:Individual
Prefix:
First Name:MARCIA
Middle Name:MEGAN
Last Name:COLE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2405 ATHERHOLT RD
Mailing Address - Street 2:
Mailing Address - City:LYNCHBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24501-2184
Mailing Address - Country:US
Mailing Address - Phone:434-485-8500
Mailing Address - Fax:434-485-8599
Practice Address - Street 1:2405 ATHERHOLT RD
Practice Address - Street 2:
Practice Address - City:LYNCHBURG
Practice Address - State:VA
Practice Address - Zip Code:24501-2184
Practice Address - Country:US
Practice Address - Phone:434-485-8500
Practice Address - Fax:434-485-8599
Is Sole Proprietor?:No
Enumeration Date:2005-09-16
Last Update Date:2009-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0110002756363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAP00686672OtherMEDICARE RAILROAD
P00352604OtherRAILROAD MEDICARE
VAP00686672OtherMEDICARE RAILROAD
VA017263T88Medicare PIN
2762036Medicare ID - Type Unspecified