Provider Demographics
NPI:1417281965
Name:COASTAL CAROLINA NEUROLOGY, P.A.
Entity Type:Organization
Organization Name:COASTAL CAROLINA NEUROLOGY, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING
Authorized Official - Prefix:
Authorized Official - First Name:CLAUDIA
Authorized Official - Middle Name:
Authorized Official - Last Name:YALDEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:252-634-2900
Mailing Address - Street 1:2402 MARTIN LUTHER KING BLVD
Mailing Address - Street 2:
Mailing Address - City:NEW BERN
Mailing Address - State:NC
Mailing Address - Zip Code:28562-4424
Mailing Address - Country:US
Mailing Address - Phone:252-634-2900
Mailing Address - Fax:252-634-2920
Practice Address - Street 1:2402 MARTIN LUTHER KING JR BLVD
Practice Address - Street 2:
Practice Address - City:NEW BERN
Practice Address - State:NC
Practice Address - Zip Code:28562-4424
Practice Address - Country:US
Practice Address - Phone:252-634-2900
Practice Address - Fax:252-634-2920
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-30
Last Update Date:2010-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC10389174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty