Provider Demographics
NPI:1154450815
Name:COASTAL EAR NOSE & THROAT PC
Entity Type:Organization
Organization Name:COASTAL EAR NOSE & THROAT PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:P
Authorized Official - Last Name:GIOVAGNOLI
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:843-979-3889
Mailing Address - Street 1:PO BOX 3847
Mailing Address - Street 2:
Mailing Address - City:PAWLEYS ISLAND
Mailing Address - State:SC
Mailing Address - Zip Code:29585
Mailing Address - Country:US
Mailing Address - Phone:843-979-3889
Mailing Address - Fax:843-979-3892
Practice Address - Street 1:36 BUSINESS CENTER DR
Practice Address - Street 2:
Practice Address - City:PAWLEYS ISLAND
Practice Address - State:SC
Practice Address - Zip Code:29585
Practice Address - Country:US
Practice Address - Phone:843-979-3889
Practice Address - Fax:843-979-3892
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
A82860Medicare UPIN
SC6P2448Medicare ID - Type Unspecified
A28600281Medicare ID - Type Unspecified