Provider Demographics
NPI:1609818384
Name:COASTAL ARTHRITIS AND RHEUMATISM ASSOCIATES PA
Entity Type:Organization
Organization Name:COASTAL ARTHRITIS AND RHEUMATISM ASSOCIATES PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:DONALD
Authorized Official - Last Name:FRASER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:910-577-0177
Mailing Address - Street 1:1126B KELLUM LOOP RD
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28546-3304
Mailing Address - Country:US
Mailing Address - Phone:910-577-0177
Mailing Address - Fax:910-577-0183
Practice Address - Street 1:1126B KELLUM LOOP RD
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:NC
Practice Address - Zip Code:28546-3304
Practice Address - Country:US
Practice Address - Phone:910-577-0177
Practice Address - Fax:910-577-0183
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-10
Last Update Date:2011-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC31985207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8933694Medicaid
NCE67827Medicare UPIN
NC2344343AMedicare ID - Type Unspecified