Provider Demographics
NPI:1972530194
Name:COGHLIN, THOMAS J (MD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:J
Last Name:COGHLIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:150 EAST MANNING STREET
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02906
Mailing Address - Country:US
Mailing Address - Phone:401-272-2020
Mailing Address - Fax:401-421-5979
Practice Address - Street 1:55 VILLAGE SQUARE DRIVE
Practice Address - Street 2:BUILDING 24
Practice Address - City:SOUTH KINGSTOWN
Practice Address - State:RI
Practice Address - Zip Code:02879
Practice Address - Country:US
Practice Address - Phone:401-272-2020
Practice Address - Fax:401-789-4113
Is Sole Proprietor?:No
Enumeration Date:2006-06-26
Last Update Date:2013-09-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA30866207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
000899OtherBLUE CHIP
AA41514OtherHARVARD PILGRIM
RITC00223Medicaid
RI0800100OtherUNITED HEALTHCARE
5007211OtherAETNA NONHMO
7243170001OtherCIGNA
718112OtherTUFTS
050369447OtherVISION SERVICE PLAN
0550502OtherAETNA HMO
1102OtherNEIGHBORHOOD HEALTH
RI324OtherBLUE CROSS BLUE SHIELD
180012016OtherRAILROAD MEDICARE
R001038OtherTRICARE
000899OtherBLUE CHIP
180012016OtherRAILROAD MEDICARE