Provider Demographics
NPI:1295334571
Name:COASTLINE MEDICAL LLC
Entity type:Organization
Organization Name:COASTLINE MEDICAL LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRES
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:HAMMOND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:443-235-4178
Mailing Address - Street 1:PO BOX 165
Mailing Address - Street 2:
Mailing Address - City:BERLIN
Mailing Address - State:MD
Mailing Address - Zip Code:21811-0165
Mailing Address - Country:US
Mailing Address - Phone:410-202-2770
Mailing Address - Fax:410-220-0709
Practice Address - Street 1:123 N MAIN ST UNIT 206
Practice Address - Street 2:
Practice Address - City:BERLIN
Practice Address - State:MD
Practice Address - Zip Code:21811-1554
Practice Address - Country:US
Practice Address - Phone:410-202-2770
Practice Address - Fax:410-220-0709
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-19
Last Update Date:2022-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD76413562OtherUMR