Provider Demographics
NPI:1033100243
Name:COYLE, MARY E (FNP)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:E
Last Name:COYLE
Suffix:
Gender:F
Credentials:FNP
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Mailing Address - Street 1:346 GRAND AVENUE
Mailing Address - Street 2:UNITED MEDICAL ASSOCIATES PC
Mailing Address - City:JOHNSON CITY
Mailing Address - State:NY
Mailing Address - Zip Code:13790
Mailing Address - Country:US
Mailing Address - Phone:607-770-0025
Mailing Address - Fax:607-729-3982
Practice Address - Street 1:27 PARK AVE
Practice Address - Street 2:FIFTH FLOOR
Practice Address - City:BINGHAMTON
Practice Address - State:NY
Practice Address - Zip Code:13903-1605
Practice Address - Country:US
Practice Address - Phone:607-762-2251
Practice Address - Fax:607-762-2269
Is Sole Proprietor?:No
Enumeration Date:2005-11-04
Last Update Date:2012-09-17
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NYF332729363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01992869Medicaid
NYCC2934Medicare PIN
P16568Medicare UPIN