Provider Demographics
NPI:1952368987
Name:COLEMAN, STEPHEN D (MD)
Entity type:Individual
Prefix:
First Name:STEPHEN
Middle Name:D
Last Name:COLEMAN
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 1:6 E CHESTNUT ST
Mailing Address - Street 2:SUITE C-3
Mailing Address - City:AUGUSTA
Mailing Address - State:ME
Mailing Address - Zip Code:04330-5717
Mailing Address - Country:US
Mailing Address - Phone:207-621-4600
Mailing Address - Fax:207-621-4651
Practice Address - Street 1:6 E CHESTNUT ST
Practice Address - Street 2:SUITE C-3
Practice Address - City:AUGUSTA
Practice Address - State:ME
Practice Address - Zip Code:04330-5717
Practice Address - Country:US
Practice Address - Phone:207-621-4600
Practice Address - Fax:207-621-4651
Is Sole Proprietor?:No
Enumeration Date:2006-04-26
Last Update Date:2012-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME13842207RG0100X
MEMD13842207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME1952368987Medicaid
ME337170099Medicaid
MM5435Medicare ID - Type Unspecified
ME337170099Medicaid
MEMM543501Medicare PIN