MEDICARE: PETER WILLIAM COFFMAN MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084P0800X	Psychiatry Physician	MD074063	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	000120653	OTHER	PA	HIGHMARK BLUE CROSS

General Provider Information

NPI Number	:	1174559439
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PETER WILLIAM COFFMAN MD

Provider Business Mailing Address
First Line	:	100 HOSPITAL AVE
Second Line	:
City	:	DU BOIS
State	:	PA
Zip	:	15801-1440
Country	:	US
Telephone Number	:	814-375-6379
Fax Number	:	814-375-9320

Provider Business Practice Location Address
First Line	:	1100 MILLION DOLLAR HWY
Second Line	:
City	:	SAINT MARYS
State	:	PA
Zip	:	15857-2728
Country	:	US
Telephone Number	:	814-781-5420
Fax Number	:	814-781-5483

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/25/2006
Last Update Date	:	06/06/2012

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