Provider Demographics
NPI:1104870757
Name:KOLE, EDWARD SCOTT (DO)
Entity type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:SCOTT
Last Name:KOLE
Suffix:
Gender:M
Credentials:DO
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Mailing Address - Street 1:1003 STREET RD
Mailing Address - Street 2:
Mailing Address - City:SOUTHAMPTON
Mailing Address - State:PA
Mailing Address - Zip Code:18966-4230
Mailing Address - Country:US
Mailing Address - Phone:215-354-1010
Mailing Address - Fax:215-354-1099
Practice Address - Street 1:1003 STREET RD
Practice Address - Street 2:
Practice Address - City:SOUTHAMPTON
Practice Address - State:PA
Practice Address - Zip Code:18966-4230
Practice Address - Country:US
Practice Address - Phone:215-354-1010
Practice Address - Fax:215-354-1099
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-19
Last Update Date:2007-08-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAOS-009149-L208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA011977Medicare PIN
PAG74632Medicare UPIN