Provider Demographics
NPI:1235144775
Name:COUGHLIN, COLLEEN M (MD)
Entity type:Individual
Prefix:
First Name:COLLEEN
Middle Name:M
Last Name:COUGHLIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:415 ROUTE 24 STE 7
Mailing Address - Street 2:
Mailing Address - City:CHESTER
Mailing Address - State:NJ
Mailing Address - Zip Code:07930-2920
Mailing Address - Country:US
Mailing Address - Phone:908-312-3770
Mailing Address - Fax:908-312-3771
Practice Address - Street 1:415 RTE 24 STE 7
Practice Address - Street 2:
Practice Address - City:CHESTER
Practice Address - State:NJ
Practice Address - Zip Code:07930-2920
Practice Address - Country:US
Practice Address - Phone:908-312-3770
Practice Address - Fax:908-312-3771
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2022-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA09918000207RC0000X
AK3693207UN0901X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207UN0901XAllopathic & Osteopathic PhysiciansNuclear MedicineNuclear Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK152516Medicare PIN
AKF27808Medicare UPIN