Individual
MR. OLEG COOLEY
Active
Individual
MR. OLEG COOLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
MA001256L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
001452375
BLUE SHIELD PROVIDER #
PA
Enumeration date
08/10/2006
Last updated
03/11/2021
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