Provider Demographics
NPI:1427227701
Name:COASTAL NEUROLOGY PLLC
Entity Type:Organization
Organization Name:COASTAL NEUROLOGY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:SUSAN
Authorized Official - Last Name:TORRES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:910-254-9914
Mailing Address - Street 1:PO BOX 3518
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28406-0518
Mailing Address - Country:US
Mailing Address - Phone:910-254-9914
Mailing Address - Fax:910-254-9953
Practice Address - Street 1:1514 DOCTORS CIR
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28401-7404
Practice Address - Country:US
Practice Address - Phone:910-254-9914
Practice Address - Fax:910-254-9953
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-21
Last Update Date:2015-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC341832084N0008X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0008XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeuromuscular MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5909197Medicaid
NC2160676EMedicare PIN