Healthcare Provider Details

I. General information

NPI: 1689438111
Provider Name (Legal Business Name): COASTAL PEDIATRICS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/06/2024
Last Update Date: 02/06/2024
Certification Date: 02/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19283 STATE HIGHWAY 59
SUMMERDALE AL
36580-3005
US

IV. Provider business mailing address

19283 STATE HIGHWAY 59
SUMMERDALE AL
36580-3005
US

V. Phone/Fax

Practice location:
  • Phone: 251-523-5437
  • Fax:
Mailing address:
  • Phone: 251-523-5437
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: PETER STROGOV
Title or Position: OWNER
Credential: MD
Phone: 251-523-5437