Provider Demographics
NPI:1003164922
Name:COASTAL NEPHROLOGY, P.A.
Entity Type:Organization
Organization Name:COASTAL NEPHROLOGY, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MILAGROS
Authorized Official - Middle Name:
Authorized Official - Last Name:CAILING
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:910-238-2181
Mailing Address - Street 1:123 POMPANO PL
Mailing Address - Street 2:STE 300
Mailing Address - City:JACKSONVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28546
Mailing Address - Country:US
Mailing Address - Phone:910-238-2181
Mailing Address - Fax:910-238-2185
Practice Address - Street 1:123 POMPANO PL
Practice Address - Street 2:STE 300
Practice Address - City:JACKSONVILLE
Practice Address - State:NC
Practice Address - Zip Code:28546
Practice Address - Country:US
Practice Address - Phone:910-238-2181
Practice Address - Fax:910-238-2185
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-27
Last Update Date:2012-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2005-00955207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty