Provider Demographics
NPI:1437605003
Name:COASTAL PROSTHETICS AND ORTHOTICS,LLC
Entity Type:Organization
Organization Name:COASTAL PROSTHETICS AND ORTHOTICS,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:A
Authorized Official - Last Name:SIVERD
Authorized Official - Suffix:
Authorized Official - Credentials:CPO
Authorized Official - Phone:757-892-5300
Mailing Address - Street 1:6320 N CENTER DR STE 201
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23502-4009
Mailing Address - Country:US
Mailing Address - Phone:757-892-5300
Mailing Address - Fax:
Practice Address - Street 1:1924 LANDSTOWN CENTRE WAY STE 109
Practice Address - Street 2:BOX # 13 FOR MAIL
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23456-1624
Practice Address - Country:US
Practice Address - Phone:757-892-5300
Practice Address - Fax:757-892-5303
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-01
Last Update Date:2016-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier