Provider Demographics
NPI:1003111261
Name:COLEMAN, STEVEN LEE (HOSPITAL CORPS IDC)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:LEE
Last Name:COLEMAN
Suffix:
Gender:M
Credentials:HOSPITAL CORPS IDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:821 BLASTERS CV
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23451-8189
Mailing Address - Country:US
Mailing Address - Phone:757-422-7186
Mailing Address - Fax:757-422-7944
Practice Address - Street 1:821 BLASTERS CV
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23451-8189
Practice Address - Country:US
Practice Address - Phone:757-422-7186
Practice Address - Fax:757-422-7944
Is Sole Proprietor?:No
Enumeration Date:2011-01-20
Last Update Date:2011-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman