Provider Demographics
NPI:1780601526
Name:KOLO, LUCINDA M (MD)
Entity type:Individual
Prefix:DR
First Name:LUCINDA
Middle Name:M
Last Name:KOLO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:LUCINDA
Other - Middle Name:M
Other - Last Name:KOLO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:979 WINDEMAR DR
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97520-9747
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8495 CRATER LAKE HWY
Practice Address - Street 2:
Practice Address - City:WHITE CITY
Practice Address - State:OR
Practice Address - Zip Code:97503-3011
Practice Address - Country:US
Practice Address - Phone:541-826-2111
Practice Address - Fax:541-830-3535
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR23674MD207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORBK7271721OtherDEA
OR134185Medicare ID - Type Unspecified
ORH36518Medicare UPIN