Provider Demographics
NPI:1891710778
Name:COASTAL ANESTHESIA ASSOCIATES, PA
Entity Type:Organization
Organization Name:COASTAL ANESTHESIA ASSOCIATES, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:P
Authorized Official - Last Name:LENSCH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:910-763-4555
Mailing Address - Street 1:1801 S 17TH ST
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28401-6443
Mailing Address - Country:US
Mailing Address - Phone:910-763-4555
Mailing Address - Fax:910-798-8922
Practice Address - Street 1:1801 S 17TH ST
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28401-6443
Practice Address - Country:US
Practice Address - Phone:910-763-4555
Practice Address - Fax:910-798-8922
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COASTAL ANESTHESIA ASSOCIATES, PA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-07-13
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC24267OtherMEDCOST GROUP NUMBER
NC4007773OtherBCBS TENNESSEE GROUP NO
NC0119VOtherBCBS GROUP NUMBER
2612380OtherCRNA GROUP MEDICARE NUMBE
NC890119VMedicaid
NC=========OtherCHAMPUS GROUP NUMBER
NC890119VMedicaid