Provider Demographics
NPI:1255471967
Name:COUGHLIN, CHRISTOPHER TIMOTHY (MD)
Entity Type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:TIMOTHY
Last Name:COUGHLIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8409 DAVISHIRE DR
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27615-1804
Mailing Address - Country:US
Mailing Address - Phone:919-870-1248
Mailing Address - Fax:
Practice Address - Street 1:8409 DAVISHIRE DR
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27615-1804
Practice Address - Country:US
Practice Address - Phone:919-870-1248
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist