Provider Demographics
NPI:1932628450
Name:COYNE, SUSAN O'NEIL (PA-C)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:O'NEIL
Last Name:COYNE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:SUSAN
Other - Middle Name:
Other - Last Name:COYNE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PA
Mailing Address - Street 1:5 BUCKNAM RD STE 1D
Mailing Address - Street 2:
Mailing Address - City:FALMOUTH
Mailing Address - State:ME
Mailing Address - Zip Code:04105-1208
Mailing Address - Country:US
Mailing Address - Phone:207-781-1551
Mailing Address - Fax:207-781-1552
Practice Address - Street 1:5 BUCKNAM RD STE 1D
Practice Address - Street 2:
Practice Address - City:FALMOUTH
Practice Address - State:ME
Practice Address - Zip Code:04105-1208
Practice Address - Country:US
Practice Address - Phone:207-781-1551
Practice Address - Fax:207-781-1552
Is Sole Proprietor?:No
Enumeration Date:2017-09-15
Last Update Date:2025-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPA2311363A00000X, 363AS0400X
PAMA059270363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MEPA2311OtherMAINE STATE CERTIFICATION