MEDICARE: DR. CHRISTOPHER TIMOTHY COUGHLIN 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	174400000X	Specialist		NC

General Provider Information

NPI Number	:	1255471967
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CHRISTOPHER TIMOTHY COUGHLIN MD

Provider Business Mailing Address
First Line	:	8409 DAVISHIRE DR
Second Line	:
City	:	RALEIGH
State	:	NC
Zip	:	27615-1804
Country	:	US
Telephone Number	:	919-870-1248
Fax Number	:

Provider Business Practice Location Address
First Line	:	8409 DAVISHIRE DR
Second Line	:
City	:	RALEIGH
State	:	NC
Zip	:	27615-1804
Country	:	US
Telephone Number	:	919-870-1248
Fax Number	:

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

Provider Enumeration Date	:	02/08/2007
Last Update Date	:	07/08/2007

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