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General NPI Number Information
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NPI Number | 1972530194
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Entity Type | Individual
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Provider Name | THOMAS J. COGHLIN MD
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Gender | Male
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Dates
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Enumeration Date | 06/26/2006
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Last Update Date | 09/18/2013
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Provider Practice Location Address
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Address Line | 55 VILLAGE SQUARE DRIVE BUILDING 24
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City | SOUTH KINGSTOWN
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State | RI
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Zip | 02879
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Country | US
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Telephone | 401-272-2020
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Fax | 401-789-4113
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Provider Business Mailing Address
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Address Line | 150 EAST MANNING STREET
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City | PROVIDENCE
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State | RI
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Zip | 02906
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Country | US
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Telephone | 401-272-2020
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Fax | 401-421-5979
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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 | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | 30866
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License Number State | MA
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