Provider Demographics
NPI:1497758643
Name:COLEMAN, GARY B (MD)
Entity Type:Individual
Prefix:DR
First Name:GARY
Middle Name:B
Last Name:COLEMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:2525 SOUTHEAST BLVD
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OH
Mailing Address - Zip Code:44460-3464
Mailing Address - Country:US
Mailing Address - Phone:330-332-7685
Mailing Address - Fax:330-332-7724
Practice Address - Street 1:750 E PARK AVE
Practice Address - Street 2:
Practice Address - City:COLUMBIANA
Practice Address - State:OH
Practice Address - Zip Code:44408-1448
Practice Address - Country:US
Practice Address - Phone:330-892-0442
Practice Address - Fax:330-892-0932
Is Sole Proprietor?:No
Enumeration Date:2005-05-23
Last Update Date:2023-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35066829207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH01763OtherPARAMOUNT INSURANCE
OH0977377Medicaid
OH1233464OtherUHC INSURANCE
OH406290789OtherMED MUTUAL OF OH INS.
OH000000119436OtherANTHEM INSURANCE
OH01763OtherPARAMOUNT INSURANCE
OH1233464OtherUHC INSURANCE