Provider Demographics
NPI:1033494547
Name:COASTAL CARDIOLOLGY & VASCULAR CENTER
Entity Type:Organization
Organization Name:COASTAL CARDIOLOLGY & VASCULAR CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BALA
Authorized Official - Middle Name:
Authorized Official - Last Name:NANDIGAM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:941-625-6187
Mailing Address - Street 1:1620 TAMIAMI TRL
Mailing Address - Street 2:SUITE 300
Mailing Address - City:PORT CHARLOTTE
Mailing Address - State:FL
Mailing Address - Zip Code:33948-4015
Mailing Address - Country:US
Mailing Address - Phone:941-625-6187
Mailing Address - Fax:941-625-7887
Practice Address - Street 1:1620 TAMIAMI TRL
Practice Address - Street 2:SUITE 300
Practice Address - City:PORT CHARLOTTE
Practice Address - State:FL
Practice Address - Zip Code:33948-4015
Practice Address - Country:US
Practice Address - Phone:941-625-6187
Practice Address - Fax:941-625-7887
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-15
Last Update Date:2011-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty