Healthcare Provider Details

I. General information

NPI: 1508818444
Provider Name (Legal Business Name): THADDEUS FRAZELL COLEMAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/17/2006
Last Update Date: 08/12/2026
Certification Date: 08/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

52 UNDERWOOD ST
ORLANDO FL
32806-1110
US

IV. Provider business mailing address

52 W UNDERWOOD ST MP 153
ORLANDO FL
32806
US

V. Phone/Fax

Practice location:
  • Phone: 321-842-8475
  • Fax: 407-849-6470
Mailing address:
  • Phone: 321-842-8475
  • Fax: 407-849-6470

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number49142
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: