Provider Demographics
NPI:1831188697
Name:MCCOLE, JUDITH M (DO)
Entity type:Individual
Prefix:
First Name:JUDITH
Middle Name:M
Last Name:MCCOLE
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 CONSTITUTION DR
Mailing Address - Street 2:ELLIOT FAMILY MEDICINE AT BEDFORD VILLAGE
Mailing Address - City:BEDFORD
Mailing Address - State:NH
Mailing Address - Zip Code:03110-6042
Mailing Address - Country:US
Mailing Address - Phone:603-472-7233
Mailing Address - Fax:603-472-9188
Practice Address - Street 1:15 CONSTITUTION DR
Practice Address - Street 2:ELLIOT FAMILY MEDICINE AT BEDFORD VILLAGE
Practice Address - City:BEDFORD
Practice Address - State:NH
Practice Address - Zip Code:03110-6042
Practice Address - Country:US
Practice Address - Phone:603-472-7233
Practice Address - Fax:603-472-9188
Is Sole Proprietor?:No
Enumeration Date:2005-10-14
Last Update Date:2020-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH9842207Q00000X, 207QA0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH2177680OtherAETNA
NH30010284Medicaid
080147624OtherRR MEDICARE
NHG26261OtherHPHC
NH0400276YPNH02OtherANTHEM ACES #
NH338600OtherCIGNA
NH406450OtherTUFTS
NH01-40463OtherUHC
NHP695442OtherOXFORD
NHG26261OtherANTHEM UPIN REFERRING #