Provider Demographics
NPI:1255953790
Name:COASTAL LABORATORIES, INC.
Entity type:Organization
Organization Name:COASTAL LABORATORIES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT & CEO
Authorized Official - Prefix:
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:TORMAY
Authorized Official - Last Name:BRITTON-HARR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-212-9937
Mailing Address - Street 1:2 COMPROMISE ST
Mailing Address - Street 2:
Mailing Address - City:ANNAPOLIS
Mailing Address - State:MD
Mailing Address - Zip Code:21401-1819
Mailing Address - Country:US
Mailing Address - Phone:410-212-9937
Mailing Address - Fax:
Practice Address - Street 1:4530 E SHEA BLVD STE 165
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85028-6042
Practice Address - Country:US
Practice Address - Phone:410-212-9937
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-05-07
Last Update Date:2020-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory