Provider Demographics
NPI:1245357854
Name:COASTAL THORACIC SURGICAL ASSOCIATES, PA
Entity type:Organization
Organization Name:COASTAL THORACIC SURGICAL ASSOCIATES, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:HOWARD
Authorized Official - Middle Name:F
Authorized Official - Last Name:MARKS
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:910-251-3766
Mailing Address - Street 1:1912 TRADD CT
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28401-6637
Mailing Address - Country:US
Mailing Address - Phone:910-251-3760
Mailing Address - Fax:910-251-3766
Practice Address - Street 1:1912 TRADD CT
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28401-6637
Practice Address - Country:US
Practice Address - Phone:910-251-3760
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-26
Last Update Date:2010-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)Group - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
2343275AMedicare ID - Type Unspecified
2343275Medicare UPIN