Provider Demographics
NPI:1184841181
Name:COLEMAN, STANFORD JOSEPH JR (MD, MBA)
Entity Type:Individual
Prefix:DR
First Name:STANFORD
Middle Name:JOSEPH
Last Name:COLEMAN
Suffix:JR
Gender:M
Credentials:MD, MBA
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Mailing Address - Street 1:13522 REID CIRCLE
Mailing Address - Street 2:
Mailing Address - City:FORT WASHINGTON
Mailing Address - State:MD
Mailing Address - Zip Code:20744
Mailing Address - Country:US
Mailing Address - Phone:240-604-5905
Mailing Address - Fax:410-752-7472
Practice Address - Street 1:2772 RUTLAND ROAD
Practice Address - Street 2:
Practice Address - City:DAVIDSONVILLE
Practice Address - State:MD
Practice Address - Zip Code:21035
Practice Address - Country:US
Practice Address - Phone:443-332-4380
Practice Address - Fax:410-269-0510
Is Sole Proprietor?:No
Enumeration Date:2007-04-19
Last Update Date:2020-01-28
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MDD22261207Q00000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics