MEDICARE: BRIAN E COYLE 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	208000000X	Pediatrics Physician	28673	TN
2	208000000X	Pediatrics Physician	2021-00647	NC

General Provider Information

NPI Number	:	1649244724
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRIAN E COYLE MD

Provider Business Mailing Address
First Line	:	416 MCCULLOUGH DR STE 140
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28262-4390
Country	:	US
Telephone Number	:	704-717-3383
Fax Number	:	707-717-3393

Provider Business Practice Location Address
First Line	:	416 MCCULLOUGH DR STE 140
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28262-4390
Country	:	US
Telephone Number	:	704-717-3383
Fax Number	:	704-717-3393

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

Provider Enumeration Date	:	02/15/2006
Last Update Date	:	03/08/2021

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Directions to “ BRIAN E COYLE MD” Practice Location

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