Healthcare Provider Details

I. General information

NPI: 1669114872
Provider Name (Legal Business Name): EMILY COUGHLIN DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: EMILY CERTO DO

II. Dates (important events)

Enumeration Date: 04/08/2022
Last Update Date: 10/16/2025
Certification Date: 10/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

36901 AMERICAN WAY STE C
AVON OH
44011-4058
US

IV. Provider business mailing address

23460 STONEYBROOK DR
NORTH OLMSTED OH
44070-1160
US

V. Phone/Fax

Practice location:
  • Phone: 440-930-6250
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number34.018160
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: