Individual
DR. CAROL LYNN COGLIANESE
Active
Sole proprietor
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
100 MEDICAL CENTER BLVD, SUITE 212, CONROE, TX 77304-2888
(936) 756-1322
(936) 756-1302
Mailing address
100 MEDICAL CENTER BLVD, SUITE 212, CONROE, TX 77304-2888
(936) 756-1322
(936) 756-1302
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
K7264
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0073KH
BLUE CROSS
TX
01
—
10735022
CAQH
TX
01
—
3257331
AETNA
TX
Enumeration date
06/10/2006
Last updated
07/08/2007
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