Provider Demographics
NPI:1386187599
Name:COASTAL LAB PARTNERS LLC
Entity Type:Organization
Organization Name:COASTAL LAB PARTNERS LLC
Other - Org Name:COASTAL LAB PARTNERS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP OPERATIONS
Authorized Official - Prefix:DR
Authorized Official - First Name:ALEXANDER
Authorized Official - Middle Name:L
Authorized Official - Last Name:DEMERS
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:207-689-6927
Mailing Address - Street 1:747 MAIN ST
Mailing Address - Street 2:SUITE 112
Mailing Address - City:CONCORD
Mailing Address - State:MA
Mailing Address - Zip Code:01742-3302
Mailing Address - Country:US
Mailing Address - Phone:781-964-2237
Mailing Address - Fax:
Practice Address - Street 1:747 MAIN ST
Practice Address - Street 2:SUITE 112
Practice Address - City:CONCORD
Practice Address - State:MA
Practice Address - Zip Code:01742-3302
Practice Address - Country:US
Practice Address - Phone:781-964-2237
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-21
Last Update Date:2016-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory