Provider Demographics
NPI:1326061136
Name:COLEMAN, CHARLES STEVEN (MD)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:STEVEN
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 1:150 BURNETTS WAY
Mailing Address - Street 2:SUITE 320
Mailing Address - City:SUFFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23434-8168
Mailing Address - Country:US
Mailing Address - Phone:757-934-1900
Mailing Address - Fax:757-925-6719
Practice Address - Street 1:150 BURNETTS WAY
Practice Address - Street 2:SUITE 320
Practice Address - City:SUFFOLK
Practice Address - State:VA
Practice Address - Zip Code:23434-8168
Practice Address - Country:US
Practice Address - Phone:757-934-1900
Practice Address - Fax:757-925-6719
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2010-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01012269082084N0400X, 2084S0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084S0012XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologySleep Medicine
No2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA007114613Medicaid
VA130022433OtherMEDICARE RR
VA007114613Medicaid
VA015956O04Medicare PIN
VAD50843Medicare UPIN