Provider Demographics
NPI:1407865173
Name:COASTAL KID WATCH
Entity Type:Organization
Organization Name:COASTAL KID WATCH
Other - Org Name:COASTAL KID WATCH PEDIATRICS
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PAULA
Authorized Official - Middle Name:R
Authorized Official - Last Name:NADIG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:1302-226-5225
Mailing Address - Street 1:34 CLUB HOUSE DR
Mailing Address - Street 2:OLD LANDING WOODS
Mailing Address - City:REHOBOTH BEACH
Mailing Address - State:DE
Mailing Address - Zip Code:19971-9679
Mailing Address - Country:US
Mailing Address - Phone:302-226-5225
Mailing Address - Fax:302-226-5585
Practice Address - Street 1:203 ATLANTIC AVE
Practice Address - Street 2:SUITE # 1
Practice Address - City:MILLVILLE
Practice Address - State:DE
Practice Address - Zip Code:19967-6724
Practice Address - Country:US
Practice Address - Phone:302-537-0793
Practice Address - Fax:302-537-0795
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DE006411221241261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty