Provider Demographics
NPI:1255165619
Name:COASTAL CARDIOVASCULAR ASSOCIATES, PA
Entity type:Organization
Organization Name:COASTAL CARDIOVASCULAR ASSOCIATES, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF MEDICAL OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:P
Authorized Official - Last Name:BUCHANAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:910-998-6870
Mailing Address - Street 1:1717 SHIPYARD BLVD STE 220
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28403-8019
Mailing Address - Country:US
Mailing Address - Phone:910-685-3177
Mailing Address - Fax:833-973-5142
Practice Address - Street 1:1717 SHIPYARD BLVD STE 220
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28403-8019
Practice Address - Country:US
Practice Address - Phone:910-685-3177
Practice Address - Fax:833-973-5142
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-28
Last Update Date:2024-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional CardiologyGroup - Multi-Specialty
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty