Provider Demographics
NPI:1114902236
Name:COY, MARY JANET (PA-C, RD, LD)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:JANET
Last Name:COY
Suffix:
Gender:F
Credentials:PA-C, RD, LD
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:JANET
Other - Last Name:TYE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C, RD, LD
Mailing Address - Street 1:1001 G ST NW
Mailing Address - Street 2:SUITE 200E
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20001-4545
Mailing Address - Country:US
Mailing Address - Phone:202-660-0015
Mailing Address - Fax:
Practice Address - Street 1:1001 G ST NW
Practice Address - Street 2:SUITE 200E
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20001-4545
Practice Address - Country:US
Practice Address - Phone:202-660-0015
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-13
Last Update Date:2014-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALD002606133V00000X
VA0110003424363A00000X
DCPA030929363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAD000Medicare UPIN