Provider Demographics
NPI:1467480608
Name:COYLE, JOHNSON GRAHAM (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHNSON
Middle Name:GRAHAM
Last Name:COYLE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:205 GRANDVIEW AVE
Mailing Address - Street 2:SUITE 210
Mailing Address - City:CAMP HILL
Mailing Address - State:PA
Mailing Address - Zip Code:17011-1708
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:431 N 21ST ST
Practice Address - Street 2:
Practice Address - City:CAMP HILL
Practice Address - State:PA
Practice Address - Zip Code:17011-2202
Practice Address - Country:US
Practice Address - Phone:717-763-3730
Practice Address - Fax:717-763-3734
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2013-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD025669E207P00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAA99076Medicare UPIN