1295052603 NPI number — PAUL D. COLEMAN, MD, MPA, CO

Table of content: (NPI 1295052603)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1295052603 NPI number — PAUL D. COLEMAN, MD, MPA, CO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PAUL D. COLEMAN, MD, MPA, CO
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1295052603
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/24/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
107 5TH ST SE
Provider Second Line Business Mailing Address:
SUITE 9
Provider Business Mailing Address City Name:
BARBERTON
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
44203-4269
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
330-848-1799
Provider Business Mailing Address Fax Number:
330-848-4324

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
107 5TH ST SE
Provider Second Line Business Practice Location Address:
SUITE 9
Provider Business Practice Location Address City Name:
BARBERTON
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44203-4269
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
330-848-1799
Provider Business Practice Location Address Fax Number:
330-848-4324
Provider Enumeration Date:
04/24/2010

Additional Information

Authorized Official

Authorized Official Last Name:
COLEMAN
Authorized Official First Name:
PAUL
Authorized Official Middle Name:
DONALD
Authorized Official Title or Position:
PHYSICIAN/OWNER
Authorized Official Telephone Number:
330-848-1799

Provider Taxonomy Codes

  • Taxonomy code: 261QH0100X , with the licence number:  35052048 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0795804 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".




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