Provider Demographics
NPI:1275531352
Name:COLEMAN, MARY THOESEN (MD)
Entity Type:Individual
Prefix:DR
First Name:MARY
Middle Name:THOESEN
Last Name:COLEMAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:10206 DORSEY POINTE CIRXLE
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40223-3576
Mailing Address - Country:US
Mailing Address - Phone:305-781-8198
Mailing Address - Fax:504-290-1127
Practice Address - Street 1:10206 DORSEY POINTE CIR
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40223-3576
Practice Address - Country:US
Practice Address - Phone:305-781-8198
Practice Address - Fax:504-290-1127
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-12
Last Update Date:2020-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY33350207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine