Provider Demographics
NPI:1245570696
Name:COUGHLIN, WARD EARL (LMT)
Entity Type:Individual
Prefix:MR
First Name:WARD
Middle Name:EARL
Last Name:COUGHLIN
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:224 BLANDING RD
Mailing Address - Street 2:
Mailing Address - City:SHERBURNE
Mailing Address - State:NY
Mailing Address - Zip Code:13460-4217
Mailing Address - Country:US
Mailing Address - Phone:607-342-6290
Mailing Address - Fax:
Practice Address - Street 1:224 BLANDING RD
Practice Address - Street 2:
Practice Address - City:SHERBURNE
Practice Address - State:NY
Practice Address - Zip Code:13460-4217
Practice Address - Country:US
Practice Address - Phone:607-342-6290
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-21
Last Update Date:2013-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY025355-1174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist