Basic Information
| Provider Information | |||||||||
| NPI: | 1003997115 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | COUGHLAN | ||||||||
| FirstName: | ANN | ||||||||
| MiddleName: | M | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5 MILES CENTER WAY | ||||||||
| Address2: | UNIT 1 | ||||||||
| City: | DAMARISCOTTA | ||||||||
| State: | ME | ||||||||
| PostalCode: | 045434067 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2075634250 | ||||||||
| FaxNumber: | 2075634561 | ||||||||
| Practice Location | |||||||||
| Address1: | 5 MILES CENTER WAY | ||||||||
| Address2: | UNIT 1 | ||||||||
| City: | DAMARISCOTTA | ||||||||
| State: | ME | ||||||||
| PostalCode: | 045434067 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2075634250 | ||||||||
| FaxNumber: | 2075634561 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/17/2006 | ||||||||
| LastUpdateDate: | 03/12/2009 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 017392 | ME | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 1699860106 | 01 | ME | NPI MILES | OTHER | 1346316973 | 01 | ME | NPI INTERNAL MEDICINE | OTHER |