Provider Demographics
NPI:1417923608
Name:COYLE, ALICE REGINA (MD)
Entity Type:Individual
Prefix:DR
First Name:ALICE
Middle Name:REGINA
Last Name:COYLE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6850 LOWS RD
Mailing Address - Street 2:
Mailing Address - City:BLOOMSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17815-8729
Mailing Address - Country:US
Mailing Address - Phone:570-784-7300
Mailing Address - Fax:570-784-7331
Practice Address - Street 1:6850 LOWS RD
Practice Address - Street 2:
Practice Address - City:BLOOMSBURG
Practice Address - State:PA
Practice Address - Zip Code:17815-8729
Practice Address - Country:US
Practice Address - Phone:570-784-7300
Practice Address - Fax:570-784-7331
Is Sole Proprietor?:No
Enumeration Date:2006-02-27
Last Update Date:2008-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD042695207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
E67270Medicare UPIN
634693Medicare ID - Type Unspecified