Provider Demographics
NPI:1528368446
Name:DARRYL M COLEMAN MD P A
Entity Type:Organization
Organization Name:DARRYL M COLEMAN MD P A
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PSYCHIATRIST
Authorized Official - Prefix:
Authorized Official - First Name:DARRYL
Authorized Official - Middle Name:M
Authorized Official - Last Name:COLEMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:410-744-7076
Mailing Address - Street 1:6630 BALTIMORE NATIONAL PIKE
Mailing Address - Street 2:205B
Mailing Address - City:CATONSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21228-3920
Mailing Address - Country:US
Mailing Address - Phone:410-744-7076
Mailing Address - Fax:
Practice Address - Street 1:6630 BALTIMORE NATIONAL PIKE
Practice Address - Street 2:205B
Practice Address - City:CATONSVILLE
Practice Address - State:MD
Practice Address - Zip Code:21228-3920
Practice Address - Country:US
Practice Address - Phone:410-744-7076
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-26
Last Update Date:2014-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD731901100Medicaid
MD319202400Medicaid