Provider Demographics
NPI:1124515150
Name:COATES, TAWANA (MD, MPH)
Entity type:Individual
Prefix:DR
First Name:TAWANA
Middle Name:
Last Name:COATES
Suffix:
Gender:F
Credentials:MD, MPH
Other - Prefix:
Other - First Name:TAWANA
Other - Middle Name:
Other - Last Name:EVANS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD, MPH
Mailing Address - Street 1:1919 STATE ST STE 340
Mailing Address - Street 2:
Mailing Address - City:NEW ALBANY
Mailing Address - State:IN
Mailing Address - Zip Code:47150-6807
Mailing Address - Country:US
Mailing Address - Phone:812-945-5233
Mailing Address - Fax:812-945-2804
Practice Address - Street 1:1919 STATE ST STE 340
Practice Address - Street 2:
Practice Address - City:NEW ALBANY
Practice Address - State:IN
Practice Address - Zip Code:47150-6807
Practice Address - Country:US
Practice Address - Phone:812-945-5233
Practice Address - Fax:812-945-2804
Is Sole Proprietor?:No
Enumeration Date:2018-04-16
Last Update Date:2023-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01088237A207V00000X
174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN300065328AMedicaid