Provider Demographics
NPI:1578587275
Name:COLEMAN, GLENDA LYNN (MD)
Entity Type:Individual
Prefix:DR
First Name:GLENDA
Middle Name:LYNN
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 130141
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77219-0141
Mailing Address - Country:US
Mailing Address - Phone:713-523-8879
Mailing Address - Fax:713-523-8879
Practice Address - Street 1:6720 BERTNER AVE
Practice Address - Street 2:ST. LUKE'S EPISCOPAL HOSPITAL
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030
Practice Address - Country:US
Practice Address - Phone:832-355-2628
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ4753207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXF46338Medicare UPIN