Provider Demographics
NPI:1124214572
Name:COUGHLIN, ELIZABETH C (NP)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:C
Last Name:COUGHLIN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:53 MARION ROAD
Mailing Address - Street 2:SUITE ONE
Mailing Address - City:WAREHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02571
Mailing Address - Country:US
Mailing Address - Phone:508-295-8622
Mailing Address - Fax:508-295-4909
Practice Address - Street 1:53 MARION ROAD
Practice Address - Street 2:SUITE ONE
Practice Address - City:WAREHAM
Practice Address - State:MA
Practice Address - Zip Code:02571
Practice Address - Country:US
Practice Address - Phone:508-295-8622
Practice Address - Fax:508-295-4909
Is Sole Proprietor?:No
Enumeration Date:2007-09-19
Last Update Date:2007-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA253690208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics