Basic Information
| Provider Information | |||||||||
| NPI: | 1437120748 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | COLDREN | ||||||||
| FirstName: | CAROL | ||||||||
| MiddleName: | L | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 495 THOMAS JONES WAY | ||||||||
| Address2: | SUITE 210 MAIN LINE HEALTH CENTER | ||||||||
| City: | EXTON | ||||||||
| State: | PA | ||||||||
| PostalCode: | 193412553 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4845658550 | ||||||||
| FaxNumber: | 6102801569 | ||||||||
| Practice Location | |||||||||
| Address1: | 495 THOMAS JONES WAY | ||||||||
| Address2: | SUITE 210 MAIN LINE HEALTH CENTER | ||||||||
| City: | EXTON | ||||||||
| State: | PA | ||||||||
| PostalCode: | 193412553 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4845658550 | ||||||||
| FaxNumber: | 6102801569 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/27/2006 | ||||||||
| LastUpdateDate: | 10/20/2011 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X | MD041974L | PA | Y | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
ID Information
| ID | Type | State | Issuer | Description | 232359401 | 01 | PA | MAIN LINE HEALTHCARE | OTHER | 001279605 | 05 | PA | MEDICAID |