Provider Demographics
NPI:1336434604
Name:COGGESHALL, WILLIAM DARGAN JR (MBA)
Entity Type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:DARGAN
Last Name:COGGESHALL
Suffix:JR
Gender:M
Credentials:MBA
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Other - Credentials:
Mailing Address - Street 1:1441 SACHEM PLACE
Mailing Address - Street 2:SUITE 3
Mailing Address - City:CHARLOTTESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22901
Mailing Address - Country:US
Mailing Address - Phone:434-220-7475
Mailing Address - Fax:434-220-7102
Practice Address - Street 1:1441 SACHEM PL
Practice Address - Street 2:SUITE 3
Practice Address - City:CHARLOTTESVILLE
Practice Address - State:VA
Practice Address - Zip Code:22901-2555
Practice Address - Country:US
Practice Address - Phone:434-220-7475
Practice Address - Fax:434-220-7102
Is Sole Proprietor?:No
Enumeration Date:2011-06-15
Last Update Date:2011-06-15
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker