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Individual

MR. MARK J. COYLE

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
PA-C

Contact information

Practice address
320 POMFRET ST, PUTNAM, CT 06260-1836
(860) 928-6541
(860) 963-6368
Mailing address
PO BOX 409010, ATLANTA, GA 30384-9010
(800) 377-8721
(304) 523-2241

Taxonomy

Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
000683
CT

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
970022874
RAILROAD
Enumeration date
02/16/2006
Last updated
09/14/2015
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