Provider Demographics
NPI:1740424092
Name:COASTAL MEDICAL CENTER PA C/O PAUL D BRUNS, JR, MD
Entity Type:Organization
Organization Name:COASTAL MEDICAL CENTER PA C/O PAUL D BRUNS, JR, MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:D
Authorized Official - Last Name:BRUNS
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:410-726-5540
Mailing Address - Street 1:12470 WENDELL HOLMES RD
Mailing Address - Street 2:
Mailing Address - City:HERNDON
Mailing Address - State:VA
Mailing Address - Zip Code:20171-2461
Mailing Address - Country:US
Mailing Address - Phone:410-726-5540
Mailing Address - Fax:
Practice Address - Street 1:6300 COASTAL HWY
Practice Address - Street 2:
Practice Address - City:OCEAN CITY
Practice Address - State:MD
Practice Address - Zip Code:21842-7312
Practice Address - Country:US
Practice Address - Phone:410-726-5540
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-29
Last Update Date:2009-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0023377261QU0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care