Provider Demographics
NPI:1750959649
Name:COLE, ABDUL RAHMAN
Entity type:Individual
Prefix:MR
First Name:ABDUL
Middle Name:RAHMAN
Last Name:COLE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5255 BALLY CASTLE CIRCLE
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22315
Mailing Address - Country:US
Mailing Address - Phone:443-325-4902
Mailing Address - Fax:
Practice Address - Street 1:5255 BALLY CASTLE CIRCLE
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22315
Practice Address - Country:US
Practice Address - Phone:443-325-4902
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-16
Last Update Date:2022-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1320048518251F00000X, 251E00000X, 251E00000X
3336M0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No251F00000XAgenciesHome Infusion
No3336M0002XSuppliersPharmacyMail Order Pharmacy