Provider Demographics
NPI:1518179852
Name:COLEMAN, ELIZABETH A (MD)
Entity Type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:A
Last Name:COLEMAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:313 WALNUT ST
Mailing Address - Street 2:SUITE 104
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28401-4067
Mailing Address - Country:US
Mailing Address - Phone:910-254-2022
Mailing Address - Fax:910-343-4227
Practice Address - Street 1:313 WALNUT ST
Practice Address - Street 2:SUITE 104
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28401-4067
Practice Address - Country:US
Practice Address - Phone:910-254-2022
Practice Address - Fax:910-343-4227
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-07
Last Update Date:2012-02-21
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NC290622084P0015X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0015XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychosomatic Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5918323Medicaid