Healthcare Provider Details

I. General information

NPI: 1093743619
Provider Name (Legal Business Name): MARY COLEMAN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/30/2006
Last Update Date: 06/25/2025
Certification Date: 06/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5005 MAIN ST TACOMA
TACOMA WA
98407-3168
US

IV. Provider business mailing address

1900 GARDEN RD STE 200
MONTEREY CA
93940-5334
US

V. Phone/Fax

Practice location:
  • Phone: 925-360-3102
  • Fax:
Mailing address:
  • Phone: 833-328-4523
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD60459088
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberG72907
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code2080P0006X
TaxonomyDevelopmental - Behavioral Pediatrics Physician
License NumberMD60459088
License Number StateWA
# 4
Primary TaxonomyN
Taxonomy Code2080P0008X
TaxonomyPediatric Neurodevelopmental Disabilities Physician
License NumberMD60459088
License Number StateWA
# 5
Primary TaxonomyY
Taxonomy Code2080P0006X
TaxonomyDevelopmental - Behavioral Pediatrics Physician
License NumberG072907
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: