Provider Demographics
NPI:1356492466
Name:COLEMAN, DOLORES L (CRNP)
Entity Type:Individual
Prefix:
First Name:DOLORES
Middle Name:L
Last Name:COLEMAN
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1111 BENFIELD BLVD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:MILLERSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21108-3002
Mailing Address - Country:US
Mailing Address - Phone:410-729-5100
Mailing Address - Fax:410-379-3591
Practice Address - Street 1:4201 MITCHELLVILLE RD
Practice Address - Street 2:SUITE 102
Practice Address - City:BOWIE
Practice Address - State:MD
Practice Address - Zip Code:20716-3163
Practice Address - Country:US
Practice Address - Phone:410-741-9000
Practice Address - Fax:410-741-0865
Is Sole Proprietor?:No
Enumeration Date:2007-01-15
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR171311363LA2200X
OHNP-00992363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDN611874OtherCDS
OH20229423Medicaid
MDMC0810792OtherDEA
OH20229423Medicaid
OHCONP00811Medicare ID - Type Unspecified