Provider Demographics
NPI:1679345847
Name:COLEMAN, ABIGAIL (PA-C)
Entity Type:Individual
Prefix:
First Name:ABIGAIL
Middle Name:
Last Name:COLEMAN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4951 WESTCROFT BLVD APT 286
Mailing Address - Street 2:
Mailing Address - City:CHANTILLY
Mailing Address - State:VA
Mailing Address - Zip Code:20151-1578
Mailing Address - Country:US
Mailing Address - Phone:570-335-7282
Mailing Address - Fax:
Practice Address - Street 1:8609 SUDLEY RD STE 105
Practice Address - Street 2:
Practice Address - City:MANASSAS
Practice Address - State:VA
Practice Address - Zip Code:20110-4500
Practice Address - Country:US
Practice Address - Phone:703-393-8883
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-23
Last Update Date:2023-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCPA200001734363A00000X
VA0110009639363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant