Provider Demographics
NPI:1467887562
Name:SOUTHCOAST CARDIOLOGY LLC
Entity Type:Organization
Organization Name:SOUTHCOAST CARDIOLOGY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MBR
Authorized Official - Prefix:
Authorized Official - First Name:ALAN
Authorized Official - Middle Name:J
Authorized Official - Last Name:WEINSHEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:774-992-7499
Mailing Address - Street 1:177 GULF RD
Mailing Address - Street 2:
Mailing Address - City:SOUTH DARTMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02748-1514
Mailing Address - Country:US
Mailing Address - Phone:774-992-7499
Mailing Address - Fax:508-999-9880
Practice Address - Street 1:275 ALLEN ST
Practice Address - Street 2:SUITE 101
Practice Address - City:NEW BEDFORD
Practice Address - State:MA
Practice Address - Zip Code:02740-3373
Practice Address - Country:US
Practice Address - Phone:774-992-7499
Practice Address - Fax:508-999-9880
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-08
Last Update Date:2014-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110099282AMedicaid
MAS100127661Medicare PIN