Healthcare Provider Details

I. General information

NPI: 1619945854
Provider Name (Legal Business Name): MICHAEL COYNE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/14/2006
Last Update Date: 11/26/2021
Certification Date: 11/26/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 LINDEN ST
BANGOR ME
04401-3411
US

IV. Provider business mailing address

30 LINDEN ST
BANGOR ME
04401-3411
US

V. Phone/Fax

Practice location:
  • Phone: 207-941-1099
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207PE0005X
TaxonomyUndersea and Hyperbaric Medicine (Emergency Medicine) Physician
License NumberMD13623
License Number StateME
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD13623
License Number StateME
# 3
Primary TaxonomyN
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License NumberMD13623
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: