MEDICARE: MARGARET COLEMAN

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	103T00000X	Psychologist	PS018634	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	PS018634	OTHER	PA	LICENSE

General Provider Information

NPI Number	:	1548745813
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARGARET COLEMAN

Provider Business Mailing Address
First Line	:	280 RIPKA ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19127-1125
Country	:	US
Telephone Number	:	513-312-5680
Fax Number	:

Provider Business Practice Location Address
First Line	:	255 S 17TH ST STE 1601
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19103-6216
Country	:	US
Telephone Number	:	267-571-7615
Fax Number	:	610-668-8609

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

Provider Enumeration Date	:	10/02/2018
Last Update Date	:	10/13/2022

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Directions to “ MARGARET COLEMAN ” Practice Location

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