Provider Demographics
NPI:1871517615
Name:COYLE, CHARLES FRANCIS JR (DPM)
Entity type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:FRANCIS
Last Name:COYLE
Suffix:JR
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:738 BEL ARBOR TRL
Mailing Address - Street 2:
Mailing Address - City:WEBSTER
Mailing Address - State:NY
Mailing Address - Zip Code:14580-9400
Mailing Address - Country:US
Mailing Address - Phone:585-872-0557
Mailing Address - Fax:585-872-0557
Practice Address - Street 1:738 BEL ARBOR TRL
Practice Address - Street 2:
Practice Address - City:WEBSTER
Practice Address - State:NY
Practice Address - Zip Code:14580-9400
Practice Address - Country:US
Practice Address - Phone:585-872-0557
Practice Address - Fax:585-872-0557
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-26
Last Update Date:2014-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYNY002374213ES0131X, 213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
No213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00418204Medicaid
NYBB3053Medicare ID - Type Unspecified
NY00418204Medicaid
NYT88431Medicare UPIN