Provider Demographics
NPI:1851748024
Name:COYER, ANNIE MAE (PA)
Entity Type:Individual
Prefix:
First Name:ANNIE
Middle Name:MAE
Last Name:COYER
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:ANNIE
Other - Middle Name:MAE
Other - Last Name:O'CONNOR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:627 N. MAIN ST
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:MD
Mailing Address - Zip Code:21629
Mailing Address - Country:US
Mailing Address - Phone:410-482-9148
Mailing Address - Fax:833-914-0405
Practice Address - Street 1:627 N. MAIN ST
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:MD
Practice Address - Zip Code:21629
Practice Address - Country:US
Practice Address - Phone:410-482-9148
Practice Address - Fax:833-914-0405
Is Sole Proprietor?:No
Enumeration Date:2016-05-18
Last Update Date:2021-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC5-0001069363A00000X
MDC0008118363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant