Individual
KELLY M COLEMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
P.A.
Contact information
Practice address
1425 PORTLAND AVE, ROCHESTER, NY 14621-3001
(585) 922-4000
Mailing address
1425 PORTLAND AVE, ROCHESTER, NY 14621-3001
(585) 922-4000
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
009715
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
03134558
—
NY
Enumeration date
08/31/2006
Last updated
09/06/2022
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