Provider Demographics
NPI:1508049198
Name:COASTAL ANESTHESIA ., INC
Entity Type:Organization
Organization Name:COASTAL ANESTHESIA ., INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:WERBIN
Authorized Official - Suffix:
Authorized Official - Credentials:CRNA
Authorized Official - Phone:757-460-0249
Mailing Address - Street 1:3884 JEFFERSON BLVD
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23455-1606
Mailing Address - Country:US
Mailing Address - Phone:757-460-0249
Mailing Address - Fax:757-460-0249
Practice Address - Street 1:3884 JEFFERSON BLVD
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23455-1606
Practice Address - Country:US
Practice Address - Phone:757-460-0249
Practice Address - Fax:757-460-0249
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-06
Last Update Date:2008-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0001090514261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA196663OtherANTHEM
VADF0637OtherRAILROAD
VAP00335734OtherRAILROAD
VADF0637OtherRAILROAD