Provider Demographics
NPI:1659337046
Name:COASTAL SURGICAL SPECIALISTS P A
Entity Type:Organization
Organization Name:COASTAL SURGICAL SPECIALISTS P A
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:A
Authorized Official - Last Name:SINNING
Authorized Official - Suffix:
Authorized Official - Credentials:M D
Authorized Official - Phone:252-638-8118
Mailing Address - Street 1:2203 NEUSE BLVD
Mailing Address - Street 2:
Mailing Address - City:NEW BERN
Mailing Address - State:NC
Mailing Address - Zip Code:28560-4311
Mailing Address - Country:US
Mailing Address - Phone:252-638-8118
Mailing Address - Fax:252-638-5192
Practice Address - Street 1:2203 NEUSE BLVD
Practice Address - Street 2:
Practice Address - City:NEW BERN
Practice Address - State:NC
Practice Address - Zip Code:28560-4311
Practice Address - Country:US
Practice Address - Phone:252-638-8118
Practice Address - Fax:252-638-5192
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-25
Last Update Date:2009-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC38894174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC01358OtherBCBS
NC8930158Medicaid
NC230267Medicare ID - Type Unspecified