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General NPI Number Information
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NPI Number | 1720040728
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Entity Type | Individual
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Provider Name | MICHAEL C COBURN MD
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Gender | Male
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Dates
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Enumeration Date | 04/05/2006
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Last Update Date | 10/04/2025
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Provider Practice Location Address
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Address Line | 1950 TOWER HILL RD
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City | NORTH KINGSTOWN
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State | RI
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Zip | 02852-6639
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Country | US
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Telephone | 401-559-3954
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Fax | 401-294-4116
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Provider Business Mailing Address
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Address Line | 1950 TOWER HILL RD
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City | NORTH KINGSTOWN
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State | RI
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Zip | 02852-6639
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Country | US
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Telephone | 401-559-3954
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Fax | 401-294-4116
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084A0401X
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Taxonomy Name | Addiction Medicine (Psychiatry & Neurology) Physician
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License Number | MD08308
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License Number State | RI
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Taxonomy #2
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Taxonomy Code | 261QR0405X
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Taxonomy Name | Substance Use Disorder Rehabilitation Clinic/Center
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License Number | MD08308
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License Number State | RI
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