Provider Demographics
NPI:1346295219
Name:COATS-WALTON, DEBRA A (MD)
Entity Type:Individual
Prefix:
First Name:DEBRA
Middle Name:A
Last Name:COATS-WALTON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4321 COLLINGTON RD STE 230
Mailing Address - Street 2:
Mailing Address - City:BOWIE
Mailing Address - State:MD
Mailing Address - Zip Code:20716-2261
Mailing Address - Country:US
Mailing Address - Phone:301-809-4321
Mailing Address - Fax:301-890-5798
Practice Address - Street 1:4321 COLLINGTON RD STE 230
Practice Address - Street 2:
Practice Address - City:BOWIE
Practice Address - State:MD
Practice Address - Zip Code:20716
Practice Address - Country:US
Practice Address - Phone:301-809-4321
Practice Address - Fax:301-809-5798
Is Sole Proprietor?:No
Enumeration Date:2006-05-22
Last Update Date:2019-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCMD21166207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLME138725OtherFL LICENSE
DC025713700Medicaid
VA5902673Medicaid
MD560001400Medicaid
FL102223900Medicaid
DC002761I17Medicare ID - Type Unspecified