Healthcare Provider Details

I. General information

NPI: 1740424092
Provider Name (Legal Business Name): COASTAL MEDICAL CENTER PA C/O PAUL D BRUNS, JR, MD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/29/2009
Last Update Date: 04/29/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6300 COASTAL HWY
OCEAN CITY MD
21842-7312
US

IV. Provider business mailing address

12470 WENDELL HOLMES RD
HERNDON VA
20171-2461
US

V. Phone/Fax

Practice location:
  • Phone: 410-726-5540
  • Fax:
Mailing address:
  • Phone: 410-726-5540
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License NumberD0023377
License Number StateMD

VIII. Authorized Official

Name: PAUL D BRUNS JR.
Title or Position: CEO
Credential: M.D.
Phone: 410-726-5540