MEDICARE: DR. MARK HERBERT 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	208VP0014X	Interventional Pain Medicine Physician	D0054622	MD

General Provider Information

NPI Number	:	1821095431
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARK HERBERT COLEMAN MD

Provider Business Mailing Address
First Line	:	11350 MCCORMICK RD
Second Line	:	EXECUTIVE PLAZA 1, SUITE 501
City	:	HUNT VALLEY
State	:	MD
Zip	:	21031-1002
Country	:	US
Telephone Number	:	410-383-7443
Fax Number	:	410-486-0399

Provider Business Practice Location Address
First Line	:	1838 GREENE TREE RD
Second Line	:	SUITE 150
City	:	PIKESVILLE
State	:	MD
Zip	:	21208-6391
Country	:	US
Telephone Number	:	410-383-7443
Fax Number	:	410-486-0399

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

Provider Enumeration Date	:	06/29/2005
Last Update Date	:	06/18/2021

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