Provider Demographics
NPI:1215936836
Name:COLEMAN, COLLEEN M (MD)
Entity type:Individual
Prefix:
First Name:COLLEEN
Middle Name:M
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 1:5 CENTRE DR
Mailing Address - Street 2:STE 1B
Mailing Address - City:MONROE TWP
Mailing Address - State:NJ
Mailing Address - Zip Code:08831-1864
Mailing Address - Country:US
Mailing Address - Phone:609-409-2777
Mailing Address - Fax:609-409-2718
Practice Address - Street 1:5 CENTRE DR
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:NJ
Practice Address - Zip Code:08831-1864
Practice Address - Country:US
Practice Address - Phone:609-409-2777
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-07-15
Last Update Date:2017-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA07917000207W00000X
PAMD426215207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0069477Medicaid
PA101467484Medicaid
NJ092967Medicare PIN
PA101467484Medicaid
NJ0069477Medicaid