Provider Demographics
NPI:1154528982
Name:COLEMAN, MICHAEL TROY (RPA RT(R))
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:TROY
Last Name:COLEMAN
Suffix:
Gender:M
Credentials:RPA RT(R)
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1414 YANCEYVILLE ST
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27405-6962
Mailing Address - Country:US
Mailing Address - Phone:336-895-1598
Mailing Address - Fax:
Practice Address - Street 1:1414 YANCEYVILLE ST
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27405-6962
Practice Address - Country:US
Practice Address - Phone:336-895-1598
Practice Address - Fax:336-390-2170
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-27
Last Update Date:2016-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA2317512471C3402X
UT02 TN 1039243U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes243U00000XTechnologists, Technicians & Other Technical Service ProvidersRadiology Practitioner Assistant
No2471C3402XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistRadiography