Provider Demographics
NPI:1487781639
Name:COLEMAN, RAYMOND LLOYD (MD)
Entity type:Individual
Prefix:DR
First Name:RAYMOND
Middle Name:LLOYD
Last Name:COLEMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501 S 54TH ST
Mailing Address - Street 2:STE 227
Mailing Address - City:PHILA
Mailing Address - State:PA
Mailing Address - Zip Code:19143-1900
Mailing Address - Country:US
Mailing Address - Phone:215-528-5288
Mailing Address - Fax:215-528-5033
Practice Address - Street 1:501 S 54TH ST
Practice Address - Street 2:STE 227
Practice Address - City:PHILA
Practice Address - State:PA
Practice Address - Zip Code:19143-1900
Practice Address - Country:US
Practice Address - Phone:215-528-5288
Practice Address - Fax:215-528-5033
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD019877E207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA336464OtherHIGHMARK BLUE SHIELD
PA0674187001OtherKEYSTONE HEALTH PLAN EAST
PA0688521Medicaid
PA0674187001OtherKEYSTONE HEALTH PLAN EAST
PA336464OtherHIGHMARK BLUE SHIELD