Healthcare Provider Details

I. General information

NPI: 1003292202
Provider Name (Legal Business Name): DARRYL M COLEMAN MD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/11/2015
Last Update Date: 01/27/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

115 N MONROE ST
BALTIMORE MD
21223-1641
US

IV. Provider business mailing address

6630 BALTIMORE NATIONAL PIKE STE 205B
CATONSVILLE MD
21228-3943
US

V. Phone/Fax

Practice location:
  • Phone: 443-708-4391
  • Fax: 443-708-4436
Mailing address:
  • Phone: 410-744-7076
  • Fax: 410-744-9563

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: DARRYL M COLEMAN
Title or Position: OWNER/PSYCHIATRIST
Credential: M.D.
Phone: 410-744-7076