Provider Demographics
NPI:1629130216
Name:COALE, JESSE A (PA-C)
Entity Type:Individual
Prefix:
First Name:JESSE
Middle Name:A
Last Name:COALE
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5030 STATE RD
Mailing Address - Street 2:SUITE 2-500
Mailing Address - City:DREXEL HILL
Mailing Address - State:PA
Mailing Address - Zip Code:19026-4605
Mailing Address - Country:US
Mailing Address - Phone:610-394-1380
Mailing Address - Fax:610-394-1385
Practice Address - Street 1:5030 STATE RD
Practice Address - Street 2:SUITE 2-500
Practice Address - City:DREXEL HILL
Practice Address - State:PA
Practice Address - Zip Code:19026-4605
Practice Address - Country:US
Practice Address - Phone:610-394-1380
Practice Address - Fax:610-394-1385
Is Sole Proprietor?:No
Enumeration Date:2006-12-14
Last Update Date:2014-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA001098L363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA044390Medicare PIN
PAR08384Medicare UPIN