Provider Demographics
NPI:1912094129
Name:CAROL ANN COOLIDGE MD PC
Entity Type:Organization
Organization Name:CAROL ANN COOLIDGE MD PC
Other - Org Name:COOLIDGE PLASTIC SURGERY CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:COOLIDGE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:843-208-2808
Mailing Address - Street 1:300 NEW RIVER PKWY
Mailing Address - Street 2:SUITE 36
Mailing Address - City:HARDEEVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29927-4545
Mailing Address - Country:US
Mailing Address - Phone:843-208-2808
Mailing Address - Fax:843-208-2809
Practice Address - Street 1:300 NEW RIVER PKWY
Practice Address - Street 2:SUITE 36
Practice Address - City:HARDEEVILLE
Practice Address - State:SC
Practice Address - Zip Code:29927-4545
Practice Address - Country:US
Practice Address - Phone:843-208-2808
Practice Address - Fax:843-208-2809
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-07
Last Update Date:2008-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC8572Medicare PIN