Provider Demographics
NPI:1063694966
Name:COLE, THEODORE J (DO)
Entity type:Individual
Prefix:DR
First Name:THEODORE
Middle Name:J
Last Name:COLE
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Gender:M
Credentials:DO
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Mailing Address - Street 1:7760 UNIVERSITY CT
Mailing Address - Street 2:SUITE C
Mailing Address - City:WEST CHESTER
Mailing Address - State:OH
Mailing Address - Zip Code:45069-3371
Mailing Address - Country:US
Mailing Address - Phone:513-563-4321
Mailing Address - Fax:513-847-1017
Practice Address - Street 1:7760 UNIVERSITY CT
Practice Address - Street 2:SUITE C
Practice Address - City:WEST CHESTER
Practice Address - State:OH
Practice Address - Zip Code:45069-3371
Practice Address - Country:US
Practice Address - Phone:513-563-4321
Practice Address - Fax:513-847-1017
Is Sole Proprietor?:No
Enumeration Date:2007-12-03
Last Update Date:2012-01-03
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Provider Licenses
StateLicense IDTaxonomies
OH34004375C207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0104689OtherUNITED HEALTHCARE
OH000000017595OtherANTHEM
OH1537037OtherUMWA HEALTH AND RETIREMEN
OH080150714OtherRR MCARE
OH0437505OtherHUMANA CHOICE CARE
OH080150714OtherRR MCARE
OH1537037OtherUMWA HEALTH AND RETIREMEN