Provider Demographics
NPI:1417908286
Name:COGHLAN, CLODAGH (NP)
Entity Type:Individual
Prefix:MS
First Name:CLODAGH
Middle Name:
Last Name:COGHLAN
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 1:368 DORSET ST
Mailing Address - Street 2:SUITE 1
Mailing Address - City:SOUTH BURLINGTON
Mailing Address - State:VT
Mailing Address - Zip Code:05403-6236
Mailing Address - Country:US
Mailing Address - Phone:802-860-1441
Mailing Address - Fax:802-860-4646
Practice Address - Street 1:368 DORSET ST
Practice Address - Street 2:SUITE 1
Practice Address - City:SOUTH BURLINGTON
Practice Address - State:VT
Practice Address - Zip Code:05403-6236
Practice Address - Country:US
Practice Address - Phone:802-860-1441
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-15
Last Update Date:2010-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT1010018859363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
VTONP1034Medicaid
VT500016102OtherRAIL ROAD MEDICARE
VTQX8739Medicare PIN
VTNP1034Medicare PIN
VTONP1034Medicaid