Provider Demographics
NPI:1407926538
Name:COLEMAN-LASTER, NICHELLE DIANE (MD)
Entity Type:Individual
Prefix:DR
First Name:NICHELLE
Middle Name:DIANE
Last Name:COLEMAN-LASTER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:NICHELLE
Other - Middle Name:
Other - Last Name:COLEMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1001 LAKESIDE AVE E
Mailing Address - Street 2:#1200
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44114-1158
Mailing Address - Country:US
Mailing Address - Phone:216-479-5541
Mailing Address - Fax:216-479-5554
Practice Address - Street 1:19999 ROCKSIDE RD
Practice Address - Street 2:
Practice Address - City:BEDFORD
Practice Address - State:OH
Practice Address - Zip Code:44146-2074
Practice Address - Country:US
Practice Address - Phone:216-621-5600
Practice Address - Fax:216-479-5554
Is Sole Proprietor?:No
Enumeration Date:2006-11-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-087663207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine