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NPI Code Detail

MEDICARE: JESSICA LYNNE COLEMAN D.O.

MEDICARE: JESSICA LYNNE COLEMAN D.O.
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
1207QG0300XGeriatric Medicine (Family Medicine) Physician0102204138VA
2207Q00000XFamily Medicine Physician34.011175OH

General Provider Information

NPI Number : 1609166479
Entity Type Code : Individual
Provider Name (Legal Business Name) : JESSICA LYNNE COLEMAN D.O.
Provider Business Mailing Address
First Line : 236 3RD ST SW
Second Line :
City : CANTON
State : OH
Zip : 44702-1607
Country : US
Telephone Number : 330-754-4431
Fax Number : 330-244-8839
Provider Business Practice Location Address
First Line : 236 3RD ST SW
Second Line :
City : CANTON
State : OH
Zip : 44702-1607
Country : US
Telephone Number : 330-754-4431
Fax Number : 330-244-8839
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/14/2011
Last Update Date : 04/08/2025

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