Provider Demographics
NPI:1346239787
Name:COLEMAN, MARTHA A (NP)
Entity Type:Individual
Prefix:
First Name:MARTHA
Middle Name:A
Last Name:COLEMAN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:146 HUDSON RD
Mailing Address - Street 2:P.O. BOX 370
Mailing Address - City:BOLTON
Mailing Address - State:MA
Mailing Address - Zip Code:01740-1444
Mailing Address - Country:US
Mailing Address - Phone:978-779-6262
Mailing Address - Fax:978-779-6264
Practice Address - Street 1:146 HUDSON RD
Practice Address - Street 2:
Practice Address - City:BOLTON
Practice Address - State:MA
Practice Address - Zip Code:01740-1444
Practice Address - Country:US
Practice Address - Phone:978-779-6262
Practice Address - Fax:978-779-6264
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA158647363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAPO9472Medicare UPIN
MANP2510Medicare ID - Type Unspecified