Healthcare Provider Details

I. General information

NPI: 1649945734
Provider Name (Legal Business Name): CHINA COLEMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/11/2021
Last Update Date: 06/30/2022
Certification Date: 06/30/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3261 OLD WASHINGTON RD STE 2020
WALDORF MD
20602-3231
US

IV. Provider business mailing address

3261 OLD WASHINGTON RD STE 2020
WALDORF MD
20602-3231
US

V. Phone/Fax

Practice location:
  • Phone: 833-936-2266
  • Fax: 800-535-9862
Mailing address:
  • Phone: 833-936-2266
  • Fax: 800-535-9862

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code247200000X
TaxonomyOther Technician
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code374700000X
TaxonomyTechnician
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code246QL0900X
TaxonomyLaboratory Management Specialist/Technologist
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code246RM2200X
TaxonomyMedical Laboratory Technician
License Number
License Number StateNULL
# 5
Primary TaxonomyY
Taxonomy Code247ZC0005X
TaxonomyClinical Laboratory Director (Non-physician)
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: