Healthcare Provider Details

I. General information

NPI: 1104355197
Provider Name (Legal Business Name): NICHOLAS JOHN COAN DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/05/2017
Last Update Date: 07/07/2026
Certification Date: 07/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 OSTRUM ST STE 1
BETHLEHEM PA
18015-1065
US

IV. Provider business mailing address

801 OSTRUM STREET
BETHLEHEM PA
18015-1000
US

V. Phone/Fax

Practice location:
  • Phone: 484-526-2200
  • Fax: 866-829-9836
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberOS026011
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number25MB10794700
License Number StateNJ
# 3
Primary TaxonomyY
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License NumberOS026011
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: