Provider Demographics
NPI:1861724478
Name:COLEMAN, LAURIE A (LMT)
Entity type:Individual
Prefix:
First Name:LAURIE
Middle Name:A
Last Name:COLEMAN
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 BRADLEE RD
Mailing Address - Street 2:LOWER LEVEL
Mailing Address - City:MEDFORD
Mailing Address - State:MA
Mailing Address - Zip Code:02155-3171
Mailing Address - Country:US
Mailing Address - Phone:781-249-5727
Mailing Address - Fax:
Practice Address - Street 1:16 BRADLEE RD
Practice Address - Street 2:LOWER LEVEL
Practice Address - City:MEDFORD
Practice Address - State:MA
Practice Address - Zip Code:02155-3171
Practice Address - Country:US
Practice Address - Phone:781-249-5727
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-06
Last Update Date:2017-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA4021174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist