Healthcare Provider Details

I. General information

NPI: 1962821991
Provider Name (Legal Business Name): BERTHINA B. COLEMAN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/07/2014
Last Update Date: 07/21/2026
Certification Date: 07/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

52 UNDERWOOD ST MP 153
ORLANDO FL
32806
US

IV. Provider business mailing address

52 UNDERWOOD ST MP 153
ORLANDO FL
32806
US

V. Phone/Fax

Practice location:
  • Phone: 321-841-2558
  • Fax: 407-849-6470
Mailing address:
  • Phone: 321-841-2558
  • Fax: 407-849-6470

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number229231
License Number StateAK
# 2
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number0101282152
License Number StateVA
# 3
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberMD60881108
License Number StateWA
# 4
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberME143518
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: