Healthcare Provider Details

I. General information

NPI: 1164664017
Provider Name (Legal Business Name): COASTAL MEDICAL ASSOCIATES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/24/2009
Last Update Date: 02/01/2023
Certification Date: 02/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

118 LONG POND RD
PLYMOUTH MA
02360-2662
US

IV. Provider business mailing address

55 FOGG RD
WEYMOUTH MA
02190-2432
US

V. Phone/Fax

Practice location:
  • Phone: 508-830-3190
  • Fax: 508-830-3170
Mailing address:
  • Phone: 781-340-4293
  • Fax: 781-340-3782

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number State

VIII. Authorized Official

Name: FREDERICK AYERS
Title or Position: PRESIDENT
Credential: M.D.
Phone: 781-340-4293