MEDICARE: COASTAL CAROLINA ALLERGY & ASTHMA ASSOCIATES, PC

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
1	207KA0200X	Allergy Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1720286743
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COASTAL CAROLINA ALLERGY & ASTHMA ASSOCIATES, PC

Provider Business Mailing Address
First Line	:	3516 CADUCEUS DR
Second Line	:
City	:	MYRTLE BEACH
State	:	SC
Zip	:	29588-2902
Country	:	US
Telephone Number	:	843-293-0093
Fax Number	:	843-293-0096

Provider Business Practice Location Address
First Line	:	3516 CADUCEUS DR
Second Line	:
City	:	MYRTLE BEACH
State	:	SC
Zip	:	29588-2902
Country	:	US
Telephone Number	:	843-293-0093
Fax Number	:	843-293-0096

Authorized Official
Title or Position	:	OWNER
Name	:	DR. MARK HUNTER SCHECKER
Credential	:	M.D.
Telephone Number	:	843-293-0093

Provider Enumeration Date	:	07/11/2007
Last Update Date	:	07/11/2007

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