Provider Demographics
NPI:1053465104
Name:J. THADDEUS COIN, PHD, MD, PLLC
Entity Type:Organization
Organization Name:J. THADDEUS COIN, PHD, MD, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:THADDEUS
Authorized Official - Last Name:COIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:910-762-9131
Mailing Address - Street 1:PO BOX 3098
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28406-0098
Mailing Address - Country:US
Mailing Address - Phone:910-762-9131
Mailing Address - Fax:910-762-1281
Practice Address - Street 1:2515 DELANEY AVE
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28403-6003
Practice Address - Country:US
Practice Address - Phone:910-762-9131
Practice Address - Fax:910-762-1281
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-23
Last Update Date:2012-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC298142084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC23534OtherBCBS
NC7923534Medicaid
NC7923534Medicaid