Provider Demographics
NPI:1255356713
Name:COASTAL PODIATRY, INC
Entity type:Organization
Organization Name:COASTAL PODIATRY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KATHLEEN
Authorized Official - Middle Name:M
Authorized Official - Last Name:MCGEE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:757-523-0414
Mailing Address - Street 1:6477 COLLEGE PARK SQ
Mailing Address - Street 2:SUITES 106
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23464-3611
Mailing Address - Country:US
Mailing Address - Phone:757-523-0414
Mailing Address - Fax:757-523-2047
Practice Address - Street 1:6477 COLLEGE PARK SQ
Practice Address - Street 2:SUITES 106
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23464-3611
Practice Address - Country:US
Practice Address - Phone:757-523-0414
Practice Address - Fax:757-523-2047
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-13
Last Update Date:2017-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0103000759213ES0103X, 213ES0131X, 213EP1101X, 213ER0200X, 213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
No213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
No213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot SurgeryGroup - Single Specialty
No213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric MedicineGroup - Single Specialty
No213ER0200XPodiatric Medicine & Surgery Service ProvidersPodiatristRadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAC05673Medicare ID - Type UnspecifiedPRACTICE ID#
VA4044980002Medicare NSC