Provider Demographics
NPI:1720408826
Name:COLTRAIN, JOSHUA AARON (MD)
Entity Type:Individual
Prefix:
First Name:JOSHUA
Middle Name:AARON
Last Name:COLTRAIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2509 N QUEEN ST
Mailing Address - Street 2:
Mailing Address - City:KINSTON
Mailing Address - State:NC
Mailing Address - Zip Code:28501-1632
Mailing Address - Country:US
Mailing Address - Phone:252-522-0335
Mailing Address - Fax:252-522-4016
Practice Address - Street 1:2509 N QUEEN ST
Practice Address - Street 2:
Practice Address - City:KINSTON
Practice Address - State:NC
Practice Address - Zip Code:28501-1632
Practice Address - Country:US
Practice Address - Phone:252-522-0335
Practice Address - Fax:252-522-4016
Is Sole Proprietor?:No
Enumeration Date:2014-04-16
Last Update Date:2024-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
NC200004090455208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program