Provider Demographics
NPI:1457459778
Name:COLEMAN, PAMELA W (MD)
Entity Type:Individual
Prefix:MS
First Name:PAMELA
Middle Name:W
Last Name:COLEMAN
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:PO BOX 11375
Mailing Address - Street 2:
Mailing Address - City:TAKOMA PARK
Mailing Address - State:MD
Mailing Address - Zip Code:20913-1375
Mailing Address - Country:US
Mailing Address - Phone:202-526-2890
Mailing Address - Fax:202-526-2159
Practice Address - Street 1:1160 VARNUM ST NE
Practice Address - Street 2:SUITE 318
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20017-2107
Practice Address - Country:US
Practice Address - Phone:202-526-2890
Practice Address - Fax:202-526-2159
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2019-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCLMD15767208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC01098550Medicaid
DC428121Medicare ID - Type Unspecified
DC01098550Medicaid