Provider Demographics
NPI:1295052603
Name:PAUL D. COLEMAN, MD, MPA, CO
Entity type:Organization
Organization Name:PAUL D. COLEMAN, MD, MPA, CO
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:DONALD
Authorized Official - Last Name:COLEMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:330-848-1799
Mailing Address - Street 1:107 5TH ST SE
Mailing Address - Street 2:SUITE 9
Mailing Address - City:BARBERTON
Mailing Address - State:OH
Mailing Address - Zip Code:44203-4269
Mailing Address - Country:US
Mailing Address - Phone:330-848-1799
Mailing Address - Fax:330-848-4324
Practice Address - Street 1:107 5TH ST SE
Practice Address - Street 2:SUITE 9
Practice Address - City:BARBERTON
Practice Address - State:OH
Practice Address - Zip Code:44203-4269
Practice Address - Country:US
Practice Address - Phone:330-848-1799
Practice Address - Fax:330-848-4324
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-24
Last Update Date:2010-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35052048261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0795804Medicaid