Healthcare Provider Details

I. General information

NPI: 1386801280
Provider Name (Legal Business Name): SAMUEL R COLEMAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/19/2008
Last Update Date: 06/30/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

670 LAWN AVE STE 3
SELLERSVILLE PA
18960-1571
US

IV. Provider business mailing address

670 LAWN AVE STE 3 PO BOX 440
SELLERSVILLE PA
18960-1571
US

V. Phone/Fax

Practice location:
  • Phone: 215-257-9500
  • Fax: 215-257-3578
Mailing address:
  • Phone: 215-257-9500
  • Fax: 215-257-3578

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberMD424791
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: