Healthcare Provider Details

I. General information

NPI: 1346239787
Provider Name (Legal Business Name): MARTHA A. COLEMAN NP
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 10/18/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

146 HUDSON RD
BOLTON MA
01740-1444
US

IV. Provider business mailing address

146 HUDSON RD P.O. BOX 370
BOLTON MA
01740-1444
US

V. Phone/Fax

Practice location:
  • Phone: 978-779-6262
  • Fax: 978-779-6264
Mailing address:
  • Phone: 978-779-6262
  • Fax: 978-779-6264

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number158647
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: