Provider Demographics
NPI:1104387323
Name:COLEMAN, ANTHONY L
Entity Type:Individual
Prefix:MR
First Name:ANTHONY
Middle Name:L
Last Name:COLEMAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 162
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:23868-0162
Mailing Address - Country:US
Mailing Address - Phone:434-848-8733
Mailing Address - Fax:
Practice Address - Street 1:3575 PLEASANT GROVE RD
Practice Address - Street 2:
Practice Address - City:BRODNAX
Practice Address - State:VA
Practice Address - Zip Code:23920
Practice Address - Country:US
Practice Address - Phone:434-848-8733
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-29
Last Update Date:2019-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VAT69506750343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)