Provider Demographics
NPI:1699984096
Name:COLEMAN, JULIA (PA-C)
Entity type:Individual
Prefix:MS
First Name:JULIA
Middle Name:
Last Name:COLEMAN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:43 BLACKWOOD CLEMENTON RD
Mailing Address - Street 2:
Mailing Address - City:LINDENWOLD
Mailing Address - State:NJ
Mailing Address - Zip Code:08021-3850
Mailing Address - Country:US
Mailing Address - Phone:856-627-6287
Mailing Address - Fax:856-627-6470
Practice Address - Street 1:43 BLACKWOOD CLEMENTON RD
Practice Address - Street 2:
Practice Address - City:LINDENWOLD
Practice Address - State:NJ
Practice Address - Zip Code:08021-3850
Practice Address - Country:US
Practice Address - Phone:856-627-6287
Practice Address - Fax:856-627-6470
Is Sole Proprietor?:No
Enumeration Date:2007-05-22
Last Update Date:2015-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MP00017000363AM0700X
PAMA001851L363AM0700X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical