Provider Demographics
NPI:1124095625
Name:COLEMAN, CARDELLA W (MD)
Entity type:Individual
Prefix:
First Name:CARDELLA
Middle Name:W
Last Name:COLEMAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2401 W BELVEDERE AVE
Mailing Address - Street 2:RADIATION ONCOLOGY
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21215-5216
Mailing Address - Country:US
Mailing Address - Phone:410-601-5689
Mailing Address - Fax:410-601-6307
Practice Address - Street 1:2401 W BELVEDERE AVE
Practice Address - Street 2:RADIATION ONCOLOGY
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21215-5216
Practice Address - Country:US
Practice Address - Phone:410-601-5689
Practice Address - Fax:410-601-6307
Is Sole Proprietor?:No
Enumeration Date:2006-03-02
Last Update Date:2013-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD00552102085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
920006397OtherMEDICARE RAILROAD
MDP00777329OtherRAILROAD MEDICARE PTAN
MD022302600Medicaid
MD920007555OtherRAILROAD MEDICARE
MD163609ZERQMedicare PIN
MD163462Medicare PIN
920006397OtherMEDICARE RAILROAD
MD920007555OtherRAILROAD MEDICARE
MD516M791FMedicare PIN