Provider Demographics
NPI:1487622148
Name:COGGINS, JUDINE CATHERINE (MD)
Entity type:Individual
Prefix:
First Name:JUDINE
Middle Name:CATHERINE
Last Name:COGGINS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:JUDINE
Other - Middle Name:CATHERINE
Other - Last Name:DAVIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:2157 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14214-2648
Mailing Address - Country:US
Mailing Address - Phone:716-862-1501
Mailing Address - Fax:
Practice Address - Street 1:2157 MAIN ST
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14214-2648
Practice Address - Country:US
Practice Address - Phone:716-862-1501
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-09
Last Update Date:2025-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY204770-1207VX0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYPENDINGMedicaid
NY0709273OtherINDEPENDENT HEALTH
NY000524798002OtherHEALTHNOW
NY0709273OtherINDEPENDENT HEALTH
NYPENDINGMedicaid