Provider Demographics
NPI:1821051905
Name:COASTAL ALBEMARLE ORTHOPEDICS PA
Entity Type:Organization
Organization Name:COASTAL ALBEMARLE ORTHOPEDICS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:FRANCIS
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:MCCARTHY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:252-482-5011
Mailing Address - Street 1:701 LUKE ST
Mailing Address - Street 2:
Mailing Address - City:EDENTON
Mailing Address - State:NC
Mailing Address - Zip Code:27932-9643
Mailing Address - Country:US
Mailing Address - Phone:252-482-5011
Mailing Address - Fax:252-482-0390
Practice Address - Street 1:701 LUKE ST
Practice Address - Street 2:
Practice Address - City:EDENTON
Practice Address - State:NC
Practice Address - Zip Code:27932-9643
Practice Address - Country:US
Practice Address - Phone:252-482-5011
Practice Address - Fax:252-482-0390
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-10
Last Update Date:2011-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC65914174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC890187VMedicaid
NC0187VOtherBLUE CROSS BLUE SHIELD
NC0187VOtherBLUE CROSS BLUE SHIELD