Provider Demographics
NPI:1801895420
Name:COLEMAN, BRENDA C (MD)
Entity type:Individual
Prefix:DR
First Name:BRENDA
Middle Name:C
Last Name:COLEMAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:2101 NICHOLASVILLE RD
Mailing Address - Street 2:SUITE 304
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40503-2518
Mailing Address - Country:US
Mailing Address - Phone:859-277-5771
Mailing Address - Fax:859-276-4622
Practice Address - Street 1:2101 NICHOLASVILLE RD
Practice Address - Street 2:SUITE 304
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40503-2518
Practice Address - Country:US
Practice Address - Phone:859-277-5771
Practice Address - Fax:859-276-4622
Is Sole Proprietor?:No
Enumeration Date:2005-07-15
Last Update Date:2020-12-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KY28859207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64288590Medicaid
KYF31317Medicare UPIN
1099202Medicare ID - Type Unspecified