Provider Demographics
NPI:1861750192
Name:COALSON, RICHARD CHARLES (MD)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:CHARLES
Last Name:COALSON
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 1:171 WALNUT GROVE DR
Mailing Address - Street 2:
Mailing Address - City:CENTERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:45458-4155
Mailing Address - Country:US
Mailing Address - Phone:937-885-2081
Mailing Address - Fax:937-885-2081
Practice Address - Street 1:171 WALNUT GROVE DR
Practice Address - Street 2:
Practice Address - City:CENTERVILLE
Practice Address - State:OH
Practice Address - Zip Code:45458-4155
Practice Address - Country:US
Practice Address - Phone:937-885-2081
Practice Address - Fax:937-885-2081
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-24
Last Update Date:2012-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH38109207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHF13565Medicare UPIN