Basic Information
| Provider Information | |||||||||
| NPI: | 1154769792 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | COLE | ||||||||
| FirstName: | ELIZABETH | ||||||||
| MiddleName: | KOCH | ||||||||
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| Credential: | MD | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | KOCH | ||||||||
| OtherFirstName: | ELIZABETH | ||||||||
| OtherMiddleName: | BICKET | ||||||||
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| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 101 MANNING DR | ||||||||
| Address2: | CAMPUS BOX 7085 | ||||||||
| City: | CHAPEL HILL | ||||||||
| State: | NC | ||||||||
| PostalCode: | 275997085 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9199238041 | ||||||||
| FaxNumber: | 9199662922 | ||||||||
| Practice Location | |||||||||
| Address1: | 101 MANNING DR | ||||||||
| Address2: | CAMPUS BOX 7085 | ||||||||
| City: | CHAPEL HILL | ||||||||
| State: | NC | ||||||||
| PostalCode: | 275997085 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9199238041 | ||||||||
| FaxNumber: | 9199662922 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/05/2013 | ||||||||
| LastUpdateDate: | 08/04/2022 | ||||||||
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| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | F | ||||||||
| AuthorizedOfficialLastName: | |||||||||
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| AuthorizedOfficialMiddleName: | |||||||||
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| IsSoleProprietor: | N | ||||||||
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| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | 08/04/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 2016-01229 | NC | N | Allopathic & Osteopathic Physicians | Internal Medicine | 390200000X | 191489 | NC | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 208M00000X | 2016-01229 | NC | Y | Allopathic & Osteopathic Physicians | Hospitalist |
No ID Information.