Provider Demographics
NPI:1609297548
Name:COASTAL MEDICAL ASSOCIATES, INC
Entity Type:Organization
Organization Name:COASTAL MEDICAL ASSOCIATES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER ENROLLMENT
Authorized Official - Prefix:
Authorized Official - First Name:JACLYN
Authorized Official - Middle Name:
Authorized Official - Last Name:VALANZOLA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:781-681-0384
Mailing Address - Street 1:141 LONGWATER DR STE 201
Mailing Address - Street 2:
Mailing Address - City:NORWELL
Mailing Address - State:MA
Mailing Address - Zip Code:02061-1621
Mailing Address - Country:US
Mailing Address - Phone:781-681-0384
Mailing Address - Fax:
Practice Address - Street 1:55 FOGG RD
Practice Address - Street 2:BOX 97
Practice Address - City:WEYMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02190-2432
Practice Address - Country:US
Practice Address - Phone:781-624-8719
Practice Address - Fax:781-682-5627
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-19
Last Update Date:2024-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty