Provider Demographics
NPI:1366560765
Name:COYLE, STEPHEN CONNERY (PA-C)
Entity type:Individual
Prefix:MR
First Name:STEPHEN
Middle Name:CONNERY
Last Name:COYLE
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:1245 HIGHLAND AVE
Mailing Address - Street 2:SUITE 401
Mailing Address - City:ABINGTON
Mailing Address - State:PA
Mailing Address - Zip Code:19001-3725
Mailing Address - Country:US
Mailing Address - Phone:215-481-6070
Mailing Address - Fax:215-481-6076
Practice Address - Street 1:1245 HIGHLAND AVE
Practice Address - Street 2:SUITE 401
Practice Address - City:ABINGTON
Practice Address - State:PA
Practice Address - Zip Code:19001-3725
Practice Address - Country:US
Practice Address - Phone:215-481-6070
Practice Address - Fax:215-481-6076
Is Sole Proprietor?:No
Enumeration Date:2007-03-26
Last Update Date:2018-01-19
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MA2305363A00000X
PAMA053083363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA533953Medicare PIN