Provider Demographics
NPI:1356765432
Name:DARRYL M COLEMAN MD PA
Entity type:Organization
Organization Name:DARRYL M COLEMAN MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PSYCHIATRIST
Authorized Official - Prefix:
Authorized Official - First Name:DARRYL
Authorized Official - Middle Name:M
Authorized Official - Last Name:COLEMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD,
Authorized Official - Phone:410-744-7076
Mailing Address - Street 1:115 N MONROE ST
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21223-1641
Mailing Address - Country:US
Mailing Address - Phone:410-744-7076
Mailing Address - Fax:410-744-9563
Practice Address - Street 1:6630 BALTIMORE NATIONAL PIKE STE 205B
Practice Address - Street 2:
Practice Address - City:CATONSVILLE
Practice Address - State:MD
Practice Address - Zip Code:21228-3943
Practice Address - Country:US
Practice Address - Phone:410-744-7076
Practice Address - Fax:410-744-9563
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-11
Last Update Date:2016-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD319202400Medicaid