Basic Information
| Provider Information | |||||||||
| NPI: | 1558396606 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | COLEMAN | ||||||||
| FirstName: | DAVID | ||||||||
| MiddleName: | B | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 200 GRIFFIN RD | ||||||||
| Address2: | SUITE 6 | ||||||||
| City: | PORTSMOUTH | ||||||||
| State: | NH | ||||||||
| PostalCode: | 038017145 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6036104430 | ||||||||
| FaxNumber: | 6036104432 | ||||||||
| Practice Location | |||||||||
| Address1: | 200 GRIFFIN RD | ||||||||
| Address2: | SUITE 6 | ||||||||
| City: | PORTSMOUTH | ||||||||
| State: | NH | ||||||||
| PostalCode: | 038017145 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6036104430 | ||||||||
| FaxNumber: | 6036104432 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/11/2006 | ||||||||
| LastUpdateDate: | 11/12/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 11/12/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2086S0129X | 226016 | NY | N | Allopathic & Osteopathic Physicians | Surgery | Vascular Surgery | 208600000X | 229041 | MA | N | Allopathic & Osteopathic Physicians | Surgery | 2086S0129X | 52620 | KY | N | Allopathic & Osteopathic Physicians | Surgery | Vascular Surgery | 2086S0129X | MD456855 | PA | N | Allopathic & Osteopathic Physicians | Surgery | Vascular Surgery | 2086S0129X | 14159 | NH | Y | Allopathic & Osteopathic Physicians | Surgery | Vascular Surgery |
ID Information
| ID | Type | State | Issuer | Description | 3078724 | 05 | NH | MEDICAID | P01676822 | 01 | NH | RAILROAD MEDICARE | OTHER |