Provider Demographics
NPI:1255794152
Name:COLES, COREY (MD)
Entity type:Individual
Prefix:
First Name:COREY
Middle Name:
Last Name:COLES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2503 E LYON STATION RD # 2
Mailing Address - Street 2:
Mailing Address - City:CREEDMOOR
Mailing Address - State:NC
Mailing Address - Zip Code:27522-9112
Mailing Address - Country:US
Mailing Address - Phone:919-528-1535
Mailing Address - Fax:614-533-0433
Practice Address - Street 1:2503 E LYON STATION RD # 2
Practice Address - Street 2:
Practice Address - City:CREEDMOOR
Practice Address - State:NC
Practice Address - Zip Code:27522
Practice Address - Country:US
Practice Address - Phone:919-528-1535
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-03-30
Last Update Date:2019-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2019-00454207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine