Healthcare Provider Details

I. General information

NPI: 1891796090
Provider Name (Legal Business Name): ANDREW D. COATES M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/10/2005
Last Update Date: 03/07/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 ROE AVE
ELMIRA NY
14905-1629
US

IV. Provider business mailing address

600 ROE AVE
ELMIRA NY
14905-1629
US

V. Phone/Fax

Practice location:
  • Phone: 607-271-2093
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number215785
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number215785
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: