Provider Demographics
NPI:1639512726
Name:LC COELHO MEDICAL PLLC
Entity Type:Organization
Organization Name:LC COELHO MEDICAL PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LUIZ
Authorized Official - Middle Name:
Authorized Official - Last Name:COELHO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:518-698-7544
Mailing Address - Street 1:72 HIGH ST
Mailing Address - Street 2:
Mailing Address - City:GREEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:12183-1422
Mailing Address - Country:US
Mailing Address - Phone:518-698-7544
Mailing Address - Fax:
Practice Address - Street 1:325 NORTHERN BLVD
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12204-1001
Practice Address - Country:US
Practice Address - Phone:518-698-7544
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-09
Last Update Date:2013-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY246135207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYPENDINGMedicare PIN