Provider Demographics
NPI:1124288360
Name:DYAN M. COLE MD, INC
Entity type:Organization
Organization Name:DYAN M. COLE MD, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DYAN
Authorized Official - Middle Name:M
Authorized Official - Last Name:COLE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:818-559-7295
Mailing Address - Street 1:401 S GLENOAKS BLVD
Mailing Address - Street 2:STE. # 203B
Mailing Address - City:BURBANK
Mailing Address - State:CA
Mailing Address - Zip Code:91502-1448
Mailing Address - Country:US
Mailing Address - Phone:818-559-7295
Mailing Address - Fax:818-841-9068
Practice Address - Street 1:401 S GLENOAKS BLVD
Practice Address - Street 2:STE. # 203B
Practice Address - City:BURBANK
Practice Address - State:CA
Practice Address - Zip Code:91502-1448
Practice Address - Country:US
Practice Address - Phone:818-559-7295
Practice Address - Fax:818-841-9068
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-11
Last Update Date:2008-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAF57111Medicare UPIN