Provider Demographics
NPI:1962426791
Name:COFFEY, JOHN F (MD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:F
Last Name:COFFEY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 CANTERBURY LN
Mailing Address - Street 2:
Mailing Address - City:ST DAVIDS
Mailing Address - State:PA
Mailing Address - Zip Code:19087-4401
Mailing Address - Country:US
Mailing Address - Phone:610-687-1285
Mailing Address - Fax:
Practice Address - Street 1:3 CANTERBURY LN
Practice Address - Street 2:
Practice Address - City:ST DAVIDS
Practice Address - State:PA
Practice Address - Zip Code:19087-4401
Practice Address - Country:US
Practice Address - Phone:610-687-1285
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-26
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD015013E207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA000587449Medicaid
PA175349Medicare ID - Type Unspecified
C32835Medicare UPIN