Basic Information
| Provider Information | |||||||||
| NPI: | 1083000608 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | COLEMAN | ||||||||
| FirstName: | CASEY | ||||||||
| MiddleName: | |||||||||
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| Credential: | MD, MPH | ||||||||
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| Mailing Information | |||||||||
| Address1: | 833 CHESTNUT ST STE 300 | ||||||||
| Address2: | |||||||||
| City: | PHILADELPHIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 191074405 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2158618800 | ||||||||
| FaxNumber: | 2158618815 | ||||||||
| Practice Location | |||||||||
| Address1: | 833 CHESTNUT ST STE 300 | ||||||||
| Address2: | |||||||||
| City: | PHILADELPHIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 191074405 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3028618800 | ||||||||
| FaxNumber: | 2158618815 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/10/2015 | ||||||||
| LastUpdateDate: | 06/11/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 06/11/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | FC7973654 | DE | N | Allopathic & Osteopathic Physicians | Pediatrics | 208000000X | C7-0005924 | DE | N | Allopathic & Osteopathic Physicians | Pediatrics | 208000000X | HS000240L | PA | N | Allopathic & Osteopathic Physicians | Pediatrics | 390200000X | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 208000000X | MD464270 | PA | Y | Allopathic & Osteopathic Physicians | Pediatrics |
No ID Information.