Provider Demographics
NPI:1649677568
Name:COASTAL NEUROSURGICAL SPECIALISTS, LLC
Entity type:Organization
Organization Name:COASTAL NEUROSURGICAL SPECIALISTS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SABINO
Authorized Official - Middle Name:
Authorized Official - Last Name:DAGOSTINO
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:843-813-6364
Mailing Address - Street 1:1 26TH AVE
Mailing Address - Street 2:
Mailing Address - City:ISLE OF PALMS
Mailing Address - State:SC
Mailing Address - Zip Code:29451-2311
Mailing Address - Country:US
Mailing Address - Phone:843-813-6364
Mailing Address - Fax:
Practice Address - Street 1:9313 MEDICAL PLAZA DR STE 305
Practice Address - Street 2:
Practice Address - City:NORTH CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29406-9197
Practice Address - Country:US
Practice Address - Phone:843-553-7615
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-20
Last Update Date:2014-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCDO789207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Single Specialty