Provider Demographics
NPI:1689625139
Name:O'LOUGHLIN, COLM J (MD)
Entity Type:Individual
Prefix:DR
First Name:COLM
Middle Name:J
Last Name:O'LOUGHLIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:2417 ATRIUM DR
Mailing Address - Street 2:SUITE 150
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27607-6673
Mailing Address - Country:US
Mailing Address - Phone:919-791-2040
Mailing Address - Fax:919-791-2041
Practice Address - Street 1:2417 ATRIUM DR
Practice Address - Street 2:SUITE 150
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27607
Practice Address - Country:US
Practice Address - Phone:919-791-2040
Practice Address - Fax:919-791-2041
Is Sole Proprietor?:No
Enumeration Date:2006-05-12
Last Update Date:2018-06-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC2007-00290207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
0017273601Medicare ID - Type Unspecified
H82571Medicare UPIN