Provider Demographics
NPI:1326446030
Name:COASTAL CARDIOLOGY, LLC
Entity Type:Organization
Organization Name:COASTAL CARDIOLOGY, LLC
Other - Org Name:RAYMON K. NELSON, MD
Other - Org Type:Other Name
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:RAYMON
Authorized Official - Middle Name:K
Authorized Official - Last Name:NELSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:301-779-1166
Mailing Address - Street 1:6525 BELCREST RD
Mailing Address - Street 2:SUITE 220
Mailing Address - City:HYATTSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20782-2003
Mailing Address - Country:US
Mailing Address - Phone:301-779-1166
Mailing Address - Fax:301-779-4997
Practice Address - Street 1:6525 BELCREST RD
Practice Address - Street 2:SUITE 220
Practice Address - City:HYATTSVILLE
Practice Address - State:MD
Practice Address - Zip Code:20782-2003
Practice Address - Country:US
Practice Address - Phone:301-779-1166
Practice Address - Fax:301-779-4997
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-11
Last Update Date:2016-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0031173207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty