Provider Demographics
NPI:1518001767
Name:COLEMAN, ADELINE MABEL (MD)
Entity Type:Individual
Prefix:DR
First Name:ADELINE
Middle Name:MABEL
Last Name:COLEMAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MABEL
Other - Middle Name:K
Other - Last Name:OBENG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1420 SPRING HILL RD STE 160
Mailing Address - Street 2:
Mailing Address - City:MC LEAN
Mailing Address - State:VA
Mailing Address - Zip Code:22102-3025
Mailing Address - Country:US
Mailing Address - Phone:703-888-8589
Mailing Address - Fax:877-930-1696
Practice Address - Street 1:1420 SPRING HILL RD STE 160
Practice Address - Street 2:
Practice Address - City:MC LEAN
Practice Address - State:VA
Practice Address - Zip Code:22102-3025
Practice Address - Country:US
Practice Address - Phone:703-888-8589
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-19
Last Update Date:2023-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD79087207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD654143700Medicaid