Provider Demographics
NPI:1821095431
Name:COLEMAN, MARK HERBERT (MD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:HERBERT
Last Name:COLEMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:11350 MCCORMICK RD
Mailing Address - Street 2:EXECUTIVE PLAZA 1, SUITE 501
Mailing Address - City:HUNT VALLEY
Mailing Address - State:MD
Mailing Address - Zip Code:21031-1002
Mailing Address - Country:US
Mailing Address - Phone:410-383-7443
Mailing Address - Fax:410-486-0399
Practice Address - Street 1:1838 GREENE TREE RD
Practice Address - Street 2:SUITE 150
Practice Address - City:PIKESVILLE
Practice Address - State:MD
Practice Address - Zip Code:21208-6391
Practice Address - Country:US
Practice Address - Phone:410-383-7443
Practice Address - Fax:410-486-0399
Is Sole Proprietor?:No
Enumeration Date:2005-06-29
Last Update Date:2021-06-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MDD0054622208VP0014X, 208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD658L323YMedicare PIN
DC186733ZB0UMedicare PIN
MD81035604OtherBLUE CROSS
MDG02677D06Medicare PIN
MDG94874Medicare UPIN
MD315600100Medicaid
MDF220-0003OtherBLUE CROSS REGIONAL