MEDICARE: DR. JUANITA R 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	174400000X	Specialist	24963	NC

General Provider Information

NPI Number	:	1730140492
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JUANITA R COLEMAN MD

Provider Business Mailing Address
First Line	:	1735 CITY CENTER BLVD
Second Line	:
City	:	ELIZABETH CITY
State	:	NC
Zip	:	27909
Country	:	US
Telephone Number	:	252-338-2155
Fax Number	:	252-338-7704

Provider Business Practice Location Address
First Line	:	1735 CITY CENTER BLVD
Second Line	:
City	:	ELIZABETH CITY
State	:	NC
Zip	:	27909
Country	:	US
Telephone Number	:	252-338-2155
Fax Number	:	252-338-7704

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

Provider Enumeration Date	:	03/31/2006
Last Update Date	:	02/20/2013

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