Provider Demographics
NPI:1417205642
Name:CLOUGHERTY, COLEMAN OLIVER (DPM)
Entity Type:Individual
Prefix:
First Name:COLEMAN
Middle Name:OLIVER
Last Name:CLOUGHERTY
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6688 RIDGE RD STE 1110
Mailing Address - Street 2:
Mailing Address - City:PARMA
Mailing Address - State:OH
Mailing Address - Zip Code:44129-5706
Mailing Address - Country:US
Mailing Address - Phone:440-885-1000
Mailing Address - Fax:440-843-3690
Practice Address - Street 1:6688 RIDGE RD STE 1110
Practice Address - Street 2:
Practice Address - City:PARMA
Practice Address - State:OH
Practice Address - Zip Code:44129-5706
Practice Address - Country:US
Practice Address - Phone:440-885-1000
Practice Address - Fax:440-843-3690
Is Sole Proprietor?:No
Enumeration Date:2012-08-20
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH36003722213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery