Provider Demographics
NPI:1205534302
Name:COLEMAN, MARY MARQUITA
Entity type:Individual
Prefix:MISS
First Name:MARY
Middle Name:MARQUITA
Last Name:COLEMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:307 K ST NW APT 819
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20001-3579
Mailing Address - Country:US
Mailing Address - Phone:202-276-6787
Mailing Address - Fax:
Practice Address - Street 1:307 K ST NW APT 309
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20001-3099
Practice Address - Country:US
Practice Address - Phone:202-713-2554
Practice Address - Fax:202-842-8427
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-17
Last Update Date:2023-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC3747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC70787169Medicaid