Provider Demographics
NPI:1194783415
Name:COLE, ROBERT E (MD)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:E
Last Name:COLE
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Gender:M
Credentials:MD
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Mailing Address - Street 1:100 KINGS HIGHWAY SOUTH
Mailing Address - Street 2:PROVIDER ENROLLMENT
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14617-5504
Mailing Address - Country:US
Mailing Address - Phone:585-922-1304
Mailing Address - Fax:585-922-1399
Practice Address - Street 1:1425 PORTLAND AVE
Practice Address - Street 2:WILSON BLDG
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14621-2064
Practice Address - Country:US
Practice Address - Phone:585-338-1400
Practice Address - Fax:585-339-9442
Is Sole Proprietor?:No
Enumeration Date:2006-05-03
Last Update Date:2022-09-06
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Provider Licenses
StateLicense IDTaxonomies
NY201580207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY2038OtherSIDNEY HILLMAN
NY0113576OtherIHA
NY050922000016OtherFIDELIS
NYP010201580OtherBLUE CHOICE
NY080100691OtherMEDICARE RAILROAD
NY11121977OtherCAQH
NY00355266Medicaid
NY101626BFOtherPREFERRED CARE
NY101626BFOtherPREFERRED CARE
G55304Medicare UPIN