Healthcare Provider Details

I. General information

NPI: 1679511828
Provider Name (Legal Business Name): KIM L COLEMAN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/02/2006
Last Update Date: 05/05/2025
Certification Date: 05/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3949 BROWNING PL
RALEIGH NC
27609-6536
US

IV. Provider business mailing address

3949 BROWNING PL
RALEIGH NC
27609-6536
US

V. Phone/Fax

Practice location:
  • Phone: 919-787-7411
  • Fax:
Mailing address:
  • Phone: 919-787-7411
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085P0229X
TaxonomyPediatric Radiology Physician
License Number20498
License Number StateNE
# 2
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number20498
License Number StateNE
# 3
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number9900801
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: