Provider Demographics
NPI:1124213947
Name:EILEEN COELUS, MD, LLC
Entity Type:Organization
Organization Name:EILEEN COELUS, MD, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:EILEEN
Authorized Official - Middle Name:ELISA
Authorized Official - Last Name:COELUS
Authorized Official - Suffix:
Authorized Official - Credentials:MEDICAL DOCTOR
Authorized Official - Phone:410-638-2600
Mailing Address - Street 1:100 WALTER WARD BLVD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:ABINGDON
Mailing Address - State:MD
Mailing Address - Zip Code:21009
Mailing Address - Country:US
Mailing Address - Phone:443-512-8484
Mailing Address - Fax:410-638-2680
Practice Address - Street 1:100 WALTER WARD BLVD
Practice Address - Street 2:SUITE 200
Practice Address - City:ABINGDON
Practice Address - State:MD
Practice Address - Zip Code:21009
Practice Address - Country:US
Practice Address - Phone:443-512-8484
Practice Address - Fax:410-638-2680
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-14
Last Update Date:2008-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDM34723174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty