Provider Demographics
NPI:1992790265
Name:COLEMAN, STEPHEN RAY (MD)
Entity type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:RAY
Last Name:COLEMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5420 WADE PARK BLVD STE 106
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27607-4189
Mailing Address - Country:US
Mailing Address - Phone:919-233-5952
Mailing Address - Fax:919-854-7774
Practice Address - Street 1:8300 HEALTH PARK STE 213
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27615-4731
Practice Address - Country:US
Practice Address - Phone:919-896-7066
Practice Address - Fax:919-896-7067
Is Sole Proprietor?:No
Enumeration Date:2005-09-13
Last Update Date:2019-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC98-01216208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL42100OtherMEDICAL LICENSE
NC98-01216OtherMEDICAL LICENSE
NC98-01216OtherMEDICAL LICENSE
D55122Medicare UPIN