Provider Demographics
NPI:1679684401
Name:COGGESHALL, JONATHAN W JR (PA)
Entity Type:Individual
Prefix:
First Name:JONATHAN
Middle Name:W
Last Name:COGGESHALL
Suffix:JR
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27 MILL ST
Mailing Address - Street 2:
Mailing Address - City:WALDOBORO
Mailing Address - State:ME
Mailing Address - Zip Code:04572-6013
Mailing Address - Country:US
Mailing Address - Phone:207-832-5291
Mailing Address - Fax:
Practice Address - Street 1:27 MILL ST
Practice Address - Street 2:
Practice Address - City:WALDOBORO
Practice Address - State:ME
Practice Address - Zip Code:04572-6013
Practice Address - Country:US
Practice Address - Phone:207-832-5291
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPA-459363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
Q14043Medicare UPIN
MEAP2097Medicare ID - Type Unspecified