Provider Demographics
NPI:1548687452
Name:COLEMAN INSTITUTE RICHMOND, LLC
Entity type:Organization
Organization Name:COLEMAN INSTITUTE RICHMOND, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:GIFFORD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:804-307-0818
Mailing Address - Street 1:204 N HAMILTON ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23221-2662
Mailing Address - Country:US
Mailing Address - Phone:804-353-1230
Mailing Address - Fax:804-353-3342
Practice Address - Street 1:204 N HAMILTON ST
Practice Address - Street 2:SUITE B
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23221-2662
Practice Address - Country:US
Practice Address - Phone:804-353-1230
Practice Address - Fax:804-353-3342
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-28
Last Update Date:2025-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101037152207Q00000X
207QA0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction MedicineGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAV V 5405E102OtherPETER R COLEMAN INDIVIDUAL MEDICARE P-TAN
VA0101037152OtherPETER R COLEMAN'S VA STATE MEDICAL LICENSE NUMBER
VA0101037152OtherPETER R COLEMAN'S VA STATE MEDICAL LICENSE NUMBER