Provider Demographics
NPI:1164565834
Name:COLEMAN, DARRYL MERRIEL (MD)
Entity Type:Individual
Prefix:
First Name:DARRYL
Middle Name:MERRIEL
Last Name:COLEMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6630 BALTIMORE NATIONAL PIKE
Mailing Address - Street 2:205B
Mailing Address - City:CATONSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21228-3920
Mailing Address - Country:US
Mailing Address - Phone:410-744-7076
Mailing Address - Fax:410-744-9563
Practice Address - Street 1:6630 BALTIMORE NATIONAL PIKE
Practice Address - Street 2:205B
Practice Address - City:CATONSVILLE
Practice Address - State:MD
Practice Address - Zip Code:21228-3920
Practice Address - Country:US
Practice Address - Phone:410-744-7076
Practice Address - Fax:410-744-9563
Is Sole Proprietor?:No
Enumeration Date:2007-02-14
Last Update Date:2010-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD000469282084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD207531801Medicaid
MD207531801Medicaid
MD416QMedicare ID - Type Unspecified