Provider Demographics
NPI:1265406847
Name:COLEMAN, KATHLEEN A (NP)
Entity type:Individual
Prefix:MS
First Name:KATHLEEN
Middle Name:A
Last Name:COLEMAN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 KENALRAY RD
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:MA
Mailing Address - Zip Code:01501-2209
Mailing Address - Country:US
Mailing Address - Phone:508-832-2039
Mailing Address - Fax:508-334-5374
Practice Address - Street 1:800 WASHINGTON ST
Practice Address - Street 2:GI LIVER GROUP P.C.TUFTS MEDICAL CENTER
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02111-1552
Practice Address - Country:US
Practice Address - Phone:617-636-9502
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-13
Last Update Date:2010-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA146976363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0701424Medicaid
MAQ31005Medicare UPIN
MACO NP4844Medicare ID - Type Unspecified