Provider Demographics
NPI:1811108913
Name:COATES, JOSEPH B (MD)
Entity type:Individual
Prefix:
First Name:JOSEPH
Middle Name:B
Last Name:COATES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:4035 ELECTRIC RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24018-8433
Mailing Address - Country:US
Mailing Address - Phone:540-772-8670
Mailing Address - Fax:540-772-7901
Practice Address - Street 1:4035 ELECTRIC RD
Practice Address - Street 2:SUITE A
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24018-8433
Practice Address - Country:US
Practice Address - Phone:540-772-8670
Practice Address - Fax:540-772-7901
Is Sole Proprietor?:No
Enumeration Date:2007-05-24
Last Update Date:2021-07-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0101245898207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAVV6737AOtherMEDICARE PTAN
VAVV6737BOtherMEDICARE PTAN