Provider Demographics
NPI:1083000608
Name:COLEMAN, CASEY (MD, MPH)
Entity Type:Individual
Prefix:
First Name:CASEY
Middle Name:
Last Name:COLEMAN
Suffix:
Gender:F
Credentials:MD, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:833 CHESTNUT ST STE 300
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19107-4405
Mailing Address - Country:US
Mailing Address - Phone:215-861-8800
Mailing Address - Fax:215-861-8815
Practice Address - Street 1:833 CHESTNUT ST STE 300
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19107-4405
Practice Address - Country:US
Practice Address - Phone:302-861-8800
Practice Address - Fax:215-861-8815
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-10
Last Update Date:2020-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEFC7973654208000000X
DEC7-0005924208000000X
PAHS000240L208000000X
390200000X
PAMD464270208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program