Provider Demographics
NPI:1720061476
Name:COLE, JASMIN KILAYKO (MD)
Entity Type:Individual
Prefix:DR
First Name:JASMIN
Middle Name:KILAYKO
Last Name:COLE
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 1:6230 ROLLING RD STE J
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:22152-2326
Mailing Address - Country:US
Mailing Address - Phone:571-665-6460
Mailing Address - Fax:
Practice Address - Street 1:6230 ROLLING RD STE J
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:VA
Practice Address - Zip Code:22152-2326
Practice Address - Country:US
Practice Address - Phone:571-665-6460
Practice Address - Fax:571-665-6461
Is Sole Proprietor?:No
Enumeration Date:2005-11-28
Last Update Date:2023-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD067375L207Q00000X
VA0101243642207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine