Healthcare Provider Details

I. General information

NPI: 1306054119
Provider Name (Legal Business Name): CARRIE ALLEN COLEMAN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/18/2007
Last Update Date: 08/20/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

55 FRUIT ST FOUNDERS 4
BOSTON MA
02114-2621
US

IV. Provider business mailing address

33 KIRKLAND CIR
WELLESLEY MA
02481-4812
US

V. Phone/Fax

Practice location:
  • Phone: 617-724-2229
  • Fax:
Mailing address:
  • Phone: 617-899-5949
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number233066
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: