Provider Demographics
NPI:1275127722
Name:COASTAL DERMATOLOGY PLC
Entity Type:Organization
Organization Name:COASTAL DERMATOLOGY PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:PAULA
Authorized Official - Middle Name:LYN
Authorized Official - Last Name:CAHILL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:231-252-3200
Mailing Address - Street 1:9900 E CARTER RD
Mailing Address - Street 2:
Mailing Address - City:TRAVERSE CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49684-5528
Mailing Address - Country:US
Mailing Address - Phone:231-252-3200
Mailing Address - Fax:
Practice Address - Street 1:954 BUSINESS PARK DR STE 5
Practice Address - Street 2:
Practice Address - City:TRAVERSE CITY
Practice Address - State:MI
Practice Address - Zip Code:49686-8763
Practice Address - Country:US
Practice Address - Phone:231-252-3200
Practice Address - Fax:231-252-3206
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-25
Last Update Date:2021-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty