Individual
DR. ELLEN CELESTE GAUGHAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
159 MARGARET STREET, SUITE 500, PLATTSBURGH, NY 12901-1874
(518) 566-8603
(518) 566-8582
Mailing address
159 MARGARET STREET, SUITE 500, PLATTSBURGH, NY 12901-1874
(518) 566-8603
(518) 566-8582
Taxonomy
Speciality
Code
Description
License number
State
2084N0400X
Neurology Physician
Primary
213308
NY
208VP0000X
Pain Medicine Physician
213308
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000495471003
BLUE SHIELD OF NENY
NY
05
—
01998998
—
NY
01
—
110639300
US DEPT OF LABOR
NY
01
—
130023170
RAILROAD MEDICARE
NY
01
—
141826450
TRICARE
NY
01
—
698338
MVP
NY
01
—
8C1231
BLUE CROSS BLUE SHIELD
NY
01
—
P010213308
BC OF UTICA WATERTOWN
NY
Enumeration date
06/22/2005
Last updated
11/03/2014
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