MEDICARE: PATRICIA COGHLAN, 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	207N00000X	Dermatology Physician	A22797	CA
2	207K00000X	Allergy & Immunology Physician	A22797	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1003917667	OTHER		NPI

General Provider Information

NPI Number	:	1750568358
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PATRICIA COGHLAN, MD

Provider Business Mailing Address
First Line	:	1127 WILSHIRE BLVD STE 403
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90017-3905
Country	:	US
Telephone Number	:	213-481-2083
Fax Number	:	213-482-5613

Provider Business Practice Location Address
First Line	:	1127 WILSHIRE BLVD STE 403
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90017-3905
Country	:	US
Telephone Number	:	213-481-2083
Fax Number	:	213-482-5613

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MARCIA THOMPSON
Credential	:
Telephone Number	:	805-482-7342

Provider Enumeration Date	:	01/25/2008
Last Update Date	:	02/27/2008

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