Provider Demographics
NPI:1114082864
Name:COLEMAN, ROBERTA ELAINE (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERTA
Middle Name:ELAINE
Last Name:COLEMAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12215 BRIDGEWAY CT
Mailing Address - Street 2:
Mailing Address - City:SELLERSBURG
Mailing Address - State:IN
Mailing Address - Zip Code:47172-9672
Mailing Address - Country:US
Mailing Address - Phone:812-248-9079
Mailing Address - Fax:
Practice Address - Street 1:2201 GREENTREE N
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47129-8957
Practice Address - Country:US
Practice Address - Phone:812-283-2013
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN010300862083X0100X
KY203762083X0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
INC64719Medicare UPIN