MEDICARE: DR. REGINALD OLIVER COLEMAN I MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208000000X	Pediatrics Physician	MAO34158	NJ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1164596565
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. REGINALD OLIVER COLEMAN I MD

Provider Business Mailing Address
First Line	:	2728 KENNEDY BLVD
Second Line	:
City	:	JERSEY CITY
State	:	NJ
Zip	:	07306
Country	:	US
Telephone Number	:	201-433-7817
Fax Number	:	201-433-6044

Provider Business Practice Location Address
First Line	:	2728 KENNEDY BLVD
Second Line	:
City	:	JERSEY CITY
State	:	NJ
Zip	:	07306
Country	:	US
Telephone Number	:	201-433-7817
Fax Number	:	201-433-6044

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/17/2006
Last Update Date	:	07/08/2007

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