MEDICARE: DR. CLAUDE LEROY 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	2084P0800X	Psychiatry Physician	C37778	CA
2	2084P0804X	Child & Adolescent Psychiatry Physician	C37778	CA

General Provider Information

NPI Number	:	1396732459
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CLAUDE LEROY COLEMAN MD

Provider Business Mailing Address
First Line	:	1319 SPRATLEY ST
Second Line	:
City	:	PORTSMOUTH
State	:	VA
Zip	:	23704-1810
Country	:	US
Telephone Number	:	757-469-2676
Fax Number	:

Provider Business Practice Location Address
First Line	:	4441 E KINGS CANYON RD
Second Line	:
City	:	FRESNO
State	:	CA
Zip	:	93702-3604
Country	:	US
Telephone Number	:	757-469-2676
Fax Number	:

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

Provider Enumeration Date	:	10/04/2005
Last Update Date	:	01/10/2022

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