Provider Demographics
NPI:1881645893
Name:COASTAL CARDIOLOGY, P.A.
Entity Type:Organization
Organization Name:COASTAL CARDIOLOGY, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:VAN
Authorized Official - Middle Name:C
Authorized Official - Last Name:HENDRY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:843-377-1804
Mailing Address - Street 1:1033 SAINT ANDREWS BLVD
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29407-7156
Mailing Address - Country:US
Mailing Address - Phone:843-723-6111
Mailing Address - Fax:843-727-0973
Practice Address - Street 1:1033 SAINT ANDREWS BLVD
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29407-7156
Practice Address - Country:US
Practice Address - Phone:843-723-6161
Practice Address - Fax:843-723-0675
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-15
Last Update Date:2020-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCPA9570Medicaid
SCPA9570Medicaid