Provider Demographics
NPI:1760587034
Name:KOLEHMA, KERRI A (MD)
Entity Type:Individual
Prefix:DR
First Name:KERRI
Middle Name:A
Last Name:KOLEHMA
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 12819
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29422-2819
Mailing Address - Country:US
Mailing Address - Phone:843-762-2274
Mailing Address - Fax:843-762-2278
Practice Address - Street 1:3185 AZALEA DR
Practice Address - Street 2:COASTAL PHYSICAL MEDICINE PA
Practice Address - City:N CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29405-8211
Practice Address - Country:US
Practice Address - Phone:843-762-2274
Practice Address - Fax:843-762-2278
Is Sole Proprietor?:No
Enumeration Date:2006-09-13
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC19612174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC196120Medicaid
SC196120Medicaid