Healthcare Provider Details

I. General information

NPI: 1760428833
Provider Name (Legal Business Name): MARGARET COUGHLAN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/20/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3712 ROUTE 44
MILLBROOK NY
12545-0167
US

IV. Provider business mailing address

PO BOX 167 3712 ROUTE 44
MILLBROOK NY
12545-0167
US

V. Phone/Fax

Practice location:
  • Phone: 845-677-6767
  • Fax: 845-677-8728
Mailing address:
  • Phone: 845-677-6767
  • Fax: 845-677-8728

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number211406
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: