Provider Demographics
NPI:1417955097
Name:CRYSTAL COAST RADIATION ONCOLOGY
Entity Type:Organization
Organization Name:CRYSTAL COAST RADIATION ONCOLOGY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:AUGUST
Authorized Official - Last Name:PHILIPPART
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:252-634-9901
Mailing Address - Street 1:1425 S GLENBURNIE RD
Mailing Address - Street 2:SUITE 6
Mailing Address - City:NEW BERN
Mailing Address - State:NC
Mailing Address - Zip Code:28562-2610
Mailing Address - Country:US
Mailing Address - Phone:252-634-9901
Mailing Address - Fax:252-634-9946
Practice Address - Street 1:2000 NEUSE BLVD
Practice Address - Street 2:
Practice Address - City:NEW BERN
Practice Address - State:NC
Practice Address - Zip Code:28560-3449
Practice Address - Country:US
Practice Address - Phone:252-633-8730
Practice Address - Fax:252-633-8736
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-08
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8902713Medicaid
NC02713OtherBCBS NC GROUP NUMBER
NC8902713Medicaid
NC8902713Medicaid