Provider Demographics
NPI:1801889845
Name:COLEMAN, EDWARD JOSEPH (MD)
Entity type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:JOSEPH
Last Name:COLEMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1532 LONE OAK RD STE 445
Mailing Address - Street 2:
Mailing Address - City:PADUCAH
Mailing Address - State:KY
Mailing Address - Zip Code:42003-7943
Mailing Address - Country:US
Mailing Address - Phone:270-538-5830
Mailing Address - Fax:
Practice Address - Street 1:1532 LONE OAK RD STE 445
Practice Address - Street 2:
Practice Address - City:PADUCAH
Practice Address - State:KY
Practice Address - Zip Code:42003-7943
Practice Address - Country:US
Practice Address - Phone:270-538-5830
Practice Address - Fax:270-538-5835
Is Sole Proprietor?:No
Enumeration Date:2005-08-24
Last Update Date:2025-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY60555208G00000X, 208G00000X
OK30206208G00000X
IA47938208G00000X
WI31207208G00000X
VA0101279508208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI31595600Medicaid
WI000107665Medicare ID - Type Unspecified
WI31595600Medicaid