Provider Demographics
NPI:1346234333
Name:COASTAL GASTROENTEROLOGY, A PROF. CORP.
Entity Type:Organization
Organization Name:COASTAL GASTROENTEROLOGY, A PROF. CORP.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:H
Authorized Official - Last Name:GOLDKLANG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:760-783-0441
Mailing Address - Street 1:PO BOX 231543
Mailing Address - Street 2:
Mailing Address - City:ENCINITAS
Mailing Address - State:CA
Mailing Address - Zip Code:92023-1543
Mailing Address - Country:US
Mailing Address - Phone:760-783-0441
Mailing Address - Fax:
Practice Address - Street 1:700 GARDEN VIEW CT
Practice Address - Street 2:SUITE 102
Practice Address - City:ENCINITAS
Practice Address - State:CA
Practice Address - Zip Code:92024-2478
Practice Address - Country:US
Practice Address - Phone:760-783-0441
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-06
Last Update Date:2012-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA18081207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW17886Medicare PIN