Provider Demographics
NPI:1174103816
Name:COLEMAN, COREY JON (MD)
Entity type:Individual
Prefix:
First Name:COREY
Middle Name:JON
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 1:137 STATLER ST
Mailing Address - Street 2:
Mailing Address - City:CENTRAL CITY
Mailing Address - State:PA
Mailing Address - Zip Code:15926-1421
Mailing Address - Country:US
Mailing Address - Phone:814-410-9339
Mailing Address - Fax:
Practice Address - Street 1:320 E NORTH AVE
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15212-4772
Practice Address - Country:US
Practice Address - Phone:412-359-4905
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-08
Last Update Date:2024-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD485229207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine