Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204E00000X | Oral & Maxillofacial Surgeon | DL12206 | MA |
NPI | 1437564309 |
---|---|
Provider Name | Kathryn Coyle |
First Address | Boston, MA 02114 |
Second Address | Boston, MA 02114 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/06/2014 |
Last Update Date | 30/06/2014 |