Provider Demographics
NPI:1275621245
Name:COLEBURN, NORMAN HOPE (MD)
Entity Type:Individual
Prefix:DR
First Name:NORMAN
Middle Name:HOPE
Last Name:COLEBURN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1090 AMSTERDAM AVE STE 7G
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10025-1737
Mailing Address - Country:US
Mailing Address - Phone:212-523-3726
Mailing Address - Fax:212-523-2922
Practice Address - Street 1:1090 AMSTERDAM AVE STE 7G
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10025-1737
Practice Address - Country:US
Practice Address - Phone:212-523-3726
Practice Address - Fax:212-523-2922
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2012-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY172685208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01265145Medicaid
NY15F 271Medicare ID - Type Unspecified
NY01265145Medicaid