Provider Demographics
NPI:1669400701
Name:COLEMAN, BEVERLY G (MD)
Entity type:Individual
Prefix:
First Name:BEVERLY
Middle Name:G
Last Name:COLEMAN
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:100 PENN SQUARE EAST, 9TH FL NORTH TOWER
Mailing Address - Street 2:RADIOLOGY ASSOCIATES OF CHILDREN'S HOSPITAL
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19104-4319
Mailing Address - Country:US
Mailing Address - Phone:267-425-9232
Mailing Address - Fax:267-425-9299
Practice Address - Street 1:3401 CIVIC CENTER BLVD
Practice Address - Street 2:RADIOLOGY ASSOCIATES OF CHILDREN'S HOSPITAL
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19104-4319
Practice Address - Country:US
Practice Address - Phone:215-590-1000
Practice Address - Fax:215-590-9348
Is Sole Proprietor?:No
Enumeration Date:2006-06-29
Last Update Date:2017-03-17
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
PAMD017175E2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0006954370001Medicaid
D70020Medicare UPIN
PA0006954370001Medicaid