Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | 0101055024 | VA |
Y | 207QH0002X | Family Doctor - Hospice and Palliative Medicine | D0037142 | MD |
NPI | 1164400461 |
---|---|
Provider Name | Geoffrey Coleman |
First Address | Hagerstown, MD 21742-6710 |
Second Address | Rockville, MD 20850-4315 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/01/2006 |
Last Update Date | 31/07/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
D0037142 | MARYLAND STATE (01) | MD |
D16401 | (02) |