Provider Demographics
NPI:1013043546
Name:COULING, SIDNEY L (MD)
Entity Type:Individual
Prefix:
First Name:SIDNEY
Middle Name:L
Last Name:COULING
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:SIDNEY
Other - Middle Name:L
Other - Last Name:COULING
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:465 N CLEVELAND AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:WESTERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43082-8642
Mailing Address - Country:US
Mailing Address - Phone:614-899-0000
Mailing Address - Fax:614-899-0524
Practice Address - Street 1:465 N CLEVELAND AVE STE 200
Practice Address - Street 2:
Practice Address - City:WESTERVILLE
Practice Address - State:OH
Practice Address - Zip Code:43082-8642
Practice Address - Country:US
Practice Address - Phone:614-899-0000
Practice Address - Fax:614-899-0524
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-26
Last Update Date:2021-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35051507208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0633381Medicaid
DCAC2111487OtherDEA FEDS