MEDICARE: SPENCER COLEMAN MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	0101289166	VA
2	390200000X	Student in an Organized Health Care Education/Training Program
3	208M00000X	Hospitalist Physician	0101289166	VA

General Provider Information

NPI Number	:	1386327013
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SPENCER COLEMAN MD

Provider Business Mailing Address
First Line	:	600 GRESHAM DR # 5
Second Line	:
City	:	NORFOLK
State	:	VA
Zip	:	23507-1904
Country	:	US
Telephone Number	:	757-388-3198
Fax Number	:	757-388-4242

Provider Business Practice Location Address
First Line	:	600 GRESHAM DR # 5
Second Line	:
City	:	NORFOLK
State	:	VA
Zip	:	23507-1904
Country	:	US
Telephone Number	:	757-388-3198
Fax Number	:	757-388-4242

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/09/2023
Last Update Date	:	06/03/2026

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