Provider Demographics
NPI:1578633301
Name:COLEMAN, JASON CHANNING (MD)
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:CHANNING
Last Name:COLEMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2323 MEMORIAL AVE SUITE 10
Mailing Address - Street 2:
Mailing Address - City:LINCHBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24501
Mailing Address - Country:US
Mailing Address - Phone:434-517-8022
Mailing Address - Fax:
Practice Address - Street 1:2323 MEMORIAL AVE SUITE 10
Practice Address - Street 2:
Practice Address - City:LINCHBURG
Practice Address - State:VA
Practice Address - Zip Code:24501
Practice Address - Country:US
Practice Address - Phone:434-517-8022
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-09
Last Update Date:2021-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101237294208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics