Provider Demographics
NPI:1710331798
Name:COLEMAN, MEAGAN R (DPM)
Entity type:Individual
Prefix:DR
First Name:MEAGAN
Middle Name:R
Last Name:COLEMAN
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1043 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:FREEHOLD
Mailing Address - State:NJ
Mailing Address - Zip Code:07728-2538
Mailing Address - Country:US
Mailing Address - Phone:732-800-9000
Mailing Address - Fax:732-840-2088
Practice Address - Street 1:1043 W MAIN ST
Practice Address - Street 2:
Practice Address - City:FREEHOLD
Practice Address - State:NJ
Practice Address - Zip Code:07728-2538
Practice Address - Country:US
Practice Address - Phone:732-800-9000
Practice Address - Fax:732-840-2088
Is Sole Proprietor?:No
Enumeration Date:2016-04-15
Last Update Date:2024-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MD00349900213E00000X, 213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
No213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Multi-Specialty