Provider Demographics
NPI:1437146800
Name:COASTAL INTERNAL MEDICINE, P.A.
Entity Type:Organization
Organization Name:COASTAL INTERNAL MEDICINE, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:
Authorized Official - Last Name:CAPORINO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-763-3738
Mailing Address - Street 1:2032 S 17TH ST
Mailing Address - Street 2:STE. 101
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28401-6629
Mailing Address - Country:US
Mailing Address - Phone:910-763-3738
Mailing Address - Fax:910-763-0454
Practice Address - Street 1:2032 S 17TH ST
Practice Address - Street 2:STE. 101
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28401-6629
Practice Address - Country:US
Practice Address - Phone:910-763-3738
Practice Address - Fax:910-763-0454
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-30
Last Update Date:2008-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5906247Medicaid
NC011C0OtherBCBS
NC2287359CMedicare PIN
NCCG7064Medicare PIN