Provider Demographics
NPI:1780798363
Name:COASTAL NEPHROLOGY & HYPERTENSION PC
Entity type:Organization
Organization Name:COASTAL NEPHROLOGY & HYPERTENSION PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SHAREHOLDER
Authorized Official - Prefix:DR
Authorized Official - First Name:KULLI
Authorized Official - Middle Name:M
Authorized Official - Last Name:BARRETT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:603-436-3433
Mailing Address - Street 1:330 BORTHWICK AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:PORTSMOUTH
Mailing Address - State:NH
Mailing Address - Zip Code:03801-4174
Mailing Address - Country:US
Mailing Address - Phone:603-436-3433
Mailing Address - Fax:603-427-5115
Practice Address - Street 1:330 BORTHWICK AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:PORTSMOUTH
Practice Address - State:NH
Practice Address - Zip Code:03801-4174
Practice Address - Country:US
Practice Address - Phone:603-436-3433
Practice Address - Fax:603-427-5115
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-19
Last Update Date:2008-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30211568Medicaid
NHCM85OtherHARVARD PILGRIM
NH0005006167OtherAETNA
ME143430000Medicaid
NH30211568Medicaid
NHCH9040Medicare PIN