Healthcare Provider Details

I. General information

NPI: 1912009416
Provider Name (Legal Business Name): COASTAL ORTHOPEDICS & SPORTS MEDICINE,P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/04/2006
Last Update Date: 11/22/2023
Certification Date: 11/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14 THOMAS POINT ROAD
BRUNSWICK ME
04011
US

IV. Provider business mailing address

14 THOMAS POINT ROAD
BRUNSWICK ME
04011
US

V. Phone/Fax

Practice location:
  • Phone: 207-442-0325
  • Fax: 207-443-4578
Mailing address:
  • Phone: 207-442-0325
  • Fax: 207-443-4578

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: STEPHEN KATZ
Title or Position: OWNER
Credential: M.D.
Phone: 207-442-0325