Provider Demographics
NPI:1699791244
Name:COUGHLIN, CYNTHIA B (CNM)
Entity type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:B
Last Name:COUGHLIN
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:147 MILK ST
Mailing Address - Street 2:PROVIDER ENROLLMENT 9TH FLOOR
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02109-4806
Mailing Address - Country:US
Mailing Address - Phone:617-559-8096
Mailing Address - Fax:617-421-3487
Practice Address - Street 1:228 BILLERICA RD
Practice Address - Street 2:
Practice Address - City:CHELMSFORD
Practice Address - State:MA
Practice Address - Zip Code:01824-3604
Practice Address - Country:US
Practice Address - Phone:978-250-6200
Practice Address - Fax:978-244-6665
Is Sole Proprietor?:No
Enumeration Date:2006-07-15
Last Update Date:2009-04-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA268057176B00000X, 207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No176B00000XOther Service ProvidersMidwife