Provider Demographics
NPI:1548298326
Name:COLEMAN, HERMAN DAVID (MD)
Entity type:Individual
Prefix:DR
First Name:HERMAN
Middle Name:DAVID
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 1:96 COLD SPRING RD
Mailing Address - Street 2:
Mailing Address - City:AVON
Mailing Address - State:CT
Mailing Address - Zip Code:06001-4053
Mailing Address - Country:US
Mailing Address - Phone:860-673-4823
Mailing Address - Fax:860-404-0865
Practice Address - Street 1:96 COLD SPRING RD
Practice Address - Street 2:
Practice Address - City:AVON
Practice Address - State:CT
Practice Address - Zip Code:06001-4053
Practice Address - Country:US
Practice Address - Phone:860-673-4823
Practice Address - Fax:860-404-0865
Is Sole Proprietor?:No
Enumeration Date:2006-06-29
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0354462085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT00135446401Medicaid
CT27929OtherCONTROLLED SUBSTANCE
CT27929OtherCONTROLLED SUBSTANCE
DCBC6205670OtherDEA
CT300003602Medicare ID - Type Unspecified