Provider Demographics
NPI:1720225063
Name:COASTAL OBSTETRICS & GYNECOLOGY
Entity Type:Organization
Organization Name:COASTAL OBSTETRICS & GYNECOLOGY
Other - Org Name:COASTAL GYNECOLOGY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MORRIS
Authorized Official - Middle Name:M
Authorized Official - Last Name:ELSTEIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:757-481-4036
Mailing Address - Street 1:1744 SIR WILLIAM OSLER DRIVE
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23454
Mailing Address - Country:US
Mailing Address - Phone:757-481-4036
Mailing Address - Fax:757-481-5435
Practice Address - Street 1:1744 SIR WILLIAM OSLER DR
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23454-3003
Practice Address - Country:US
Practice Address - Phone:757-481-4036
Practice Address - Fax:757-481-5435
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-08
Last Update Date:2011-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101030465174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA6247806Medicaid
VAB09438Medicare UPIN