Provider Demographics
NPI:1114007010
Name:COASTAL GENERAL SURGICAL ASSOCIATES, PC
Entity Type:Organization
Organization Name:COASTAL GENERAL SURGICAL ASSOCIATES, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:K
Authorized Official - Last Name:CARTER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:603-431-1551
Mailing Address - Street 1:278 LAFAYETTE RD
Mailing Address - Street 2:SUITE 6
Mailing Address - City:PORTSMOUTH
Mailing Address - State:NH
Mailing Address - Zip Code:03801-5455
Mailing Address - Country:US
Mailing Address - Phone:603-431-1551
Mailing Address - Fax:
Practice Address - Street 1:278 LAFAYETTE RD
Practice Address - Street 2:SUITE 6
Practice Address - City:PORTSMOUTH
Practice Address - State:NH
Practice Address - Zip Code:03801-5455
Practice Address - Country:US
Practice Address - Phone:603-431-1551
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH6898208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME01Z034763ME01OtherANTHEM BC/BS MAINE
NH0100766Y0NH01OtherANTHEM BC/BS NH
ME01Z034763ME01OtherANTHEM BC/BS MAINE
NH0100766Y0NH01OtherANTHEM BC/BS NH