Provider Demographics
NPI:1740420199
Name:COLEMAN, JOSEPH MICHAEL (PA)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:MICHAEL
Last Name:COLEMAN
Suffix:
Gender:M
Credentials:PA
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 19305
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28219-9305
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1423 E FRANKLIN ST
Practice Address - Street 2:STE F
Practice Address - City:MONROE
Practice Address - State:NC
Practice Address - Zip Code:28112-5266
Practice Address - Country:US
Practice Address - Phone:704-667-1270
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-02-25
Last Update Date:2023-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0010-04918363A00000X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1740420199Medicaid
VAD000Medicare UPIN
NCNCJ736BMedicare PIN
NCNCJ736AMedicare PIN
NCNCJ736EMedicare PIN
NC1740420199Medicaid
NCNCJ736DMedicare PIN
NCNCJ7360386Medicare PIN