MEDICARE: MARGARET COUGHLAN M.D.

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	207Q00000X	Family Medicine Physician	211406	NY

General Provider Information

NPI Number	:	1760428833
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARGARET COUGHLAN M.D.

Provider Business Mailing Address
First Line	:	PO BOX 167
Second Line	:	3712 ROUTE 44
City	:	MILLBROOK
State	:	NY
Zip	:	12545-0167
Country	:	US
Telephone Number	:	845-677-6767
Fax Number	:	845-677-8728

Provider Business Practice Location Address
First Line	:	3712 ROUTE 44
Second Line	:
City	:	MILLBROOK
State	:	NY
Zip	:	12545-0167
Country	:	US
Telephone Number	:	845-677-6767
Fax Number	:	845-677-8728

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/20/2006
Last Update Date	:	07/08/2007

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