Basic Information
Provider Information
NPI: 1811923576
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: COFFIELD
FirstName: TERRELL
MiddleName: L
NamePrefix:  
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: PO BOX 8002
Address2:  
City: SALEM
State: NH
PostalCode: 030798002
CountryCode: US
TelephoneNumber: 8009270002
FaxNumber:  
Practice Location
Address1: 100 HOSPITAL DR
Address2:  
City: BENNINGTON
State: VT
PostalCode: 052015004
CountryCode: US
TelephoneNumber: 8024475112
FaxNumber: 8024475108
Other Information
ProviderEnumerationDate: 06/24/2006
LastUpdateDate: 10/01/2014
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
2085R0202X0420006209VTY Allopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology

No ID Information.


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