Provider Demographics
NPI:1669035820
Name:COLEMAN, EMILY LACY (MD (PENDING 5/20/19))
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:LACY
Last Name:COLEMAN
Suffix:
Gender:F
Credentials:MD (PENDING 5/20/19)
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:64 ROBBINS ST
Mailing Address - Street 2:
Mailing Address - City:WATERBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06708-2600
Mailing Address - Country:US
Mailing Address - Phone:203-573-6162
Mailing Address - Fax:203-573-6707
Practice Address - Street 1:1415 TULANE AVE FL 5
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70112-2600
Practice Address - Country:US
Practice Address - Phone:504-988-1700
Practice Address - Fax:504-988-1721
Is Sole Proprietor?:No
Enumeration Date:2019-04-15
Last Update Date:2024-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA339672207N00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program