Provider Demographics
NPI:1154363125
Name:COAKLEY, JOHN J (DO)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:J
Last Name:COAKLEY
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 RIVER RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:CONSHOHOCKEN
Mailing Address - State:PA
Mailing Address - Zip Code:19428-2439
Mailing Address - Country:US
Mailing Address - Phone:610-834-2828
Mailing Address - Fax:610-834-2862
Practice Address - Street 1:235 CANTRELL AVE
Practice Address - Street 2:
Practice Address - City:HARRISONBURG
Practice Address - State:VA
Practice Address - Zip Code:22801-3248
Practice Address - Country:US
Practice Address - Phone:540-433-4100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-12
Last Update Date:2008-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0102201828207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1841797000OtherWEST VA MEDICAID
VA10242924Medicaid
VAP00307895OtherRAILROAD MEDICARE
VA009355H12Medicare PIN
VA1841797000OtherWEST VA MEDICAID