Individual
MARGO R. COFFEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
365 MONTAUK AVE, NEW LONDON, CT 06320-4700
(860) 442-0711
Mailing address
6 LINCOLN RD, WATERFORD, CT 06385-3312
(860) 444-3366
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
000015
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
4024972
—
CT
05
—
4041679
—
CT
Enumeration date
05/04/2007
Last updated
10/27/2015
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