Provider Demographics
NPI:1487835435
Name:COASTAL UROLOGY, P.C.
Entity Type:Organization
Organization Name:COASTAL UROLOGY, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:B.
Authorized Official - Middle Name:WARREN
Authorized Official - Last Name:PECHAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:757-481-9009
Mailing Address - Street 1:1856 COLONIAL MEDICAL CT STE B
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23454-3075
Mailing Address - Country:US
Mailing Address - Phone:757-481-9009
Mailing Address - Fax:757-481-9401
Practice Address - Street 1:1856 COLONIAL MEDICAL CT STE B
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23454-3075
Practice Address - Country:US
Practice Address - Phone:757-481-9009
Practice Address - Fax:757-481-9401
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-19
Last Update Date:2007-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01011031873174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAC05629Medicare PIN