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NPI Code Detail

MEDICARE: COASTLINE MEDICAL LLC

MEDICARE: COASTLINE MEDICAL LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1332B00000XDurable Medical Equipment & Medical Supplies

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
176413562OTHERMDUMR

General Provider Information

NPI Number : 1295334571
Entity Type Code : Organization
Provider Name (Legal Business Name) : COASTLINE MEDICAL LLC
Provider Business Mailing Address
First Line : PO BOX 165
Second Line :
City : BERLIN
State : MD
Zip : 21811-0165
Country : US
Telephone Number : 410-202-2770
Fax Number : 410-220-0709
Provider Business Practice Location Address
First Line : 123 N MAIN ST UNIT 206
Second Line :
City : BERLIN
State : MD
Zip : 21811-1554
Country : US
Telephone Number : 410-202-2770
Fax Number : 410-220-0709
Authorized Official
Title or Position : PRES
Name : MR. MARK HAMMOND
Credential :
Telephone Number : 443-235-4178
Provider Enumeration Date : 10/19/2020
Last Update Date : 09/08/2022

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Directions to “COASTLINE MEDICAL LLC ” Practice Location

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