Basic Information
| Provider Information | |||||||||
| NPI: | 1457344095 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | COLEMAN | ||||||||
| FirstName: | LINDA | ||||||||
| MiddleName: | ELAINE | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 224-D CORNWALL ST. NW SUITE 403 | ||||||||
| Address2: | |||||||||
| City: | LEESBURG | ||||||||
| State: | VA | ||||||||
| PostalCode: | 201762704 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7037376010 | ||||||||
| FaxNumber: | 7034438643 | ||||||||
| Practice Location | |||||||||
| Address1: | 2 PIDGEON HILL DRIVE, SUITE 400 | ||||||||
| Address2: | |||||||||
| City: | STERLING | ||||||||
| State: | VA | ||||||||
| PostalCode: | 201656129 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7034307090 | ||||||||
| FaxNumber: | 7034449878 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/30/2005 | ||||||||
| LastUpdateDate: | 09/16/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/16/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 0101041046 | VA | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 110204717 | 01 | RR MEDICARE | OTHER | 05841518 | 05 | VA | MEDICAID |