Healthcare Provider Details

I. General information

NPI: 1003174483
Provider Name (Legal Business Name): COASTAL ORTHOPAEDICS AND SPINAL SURGERY, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/24/2012
Last Update Date: 04/24/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3310 TRENT RD
NEW BERN NC
28562-5705
US

IV. Provider business mailing address

612B MCCARTHY BLVD
NEW BERN NC
28562-5231
US

V. Phone/Fax

Practice location:
  • Phone: 252-636-0035
  • Fax: 252-636-0036
Mailing address:
  • Phone: 252-635-1788
  • Fax: 252-635-3053

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: BRIAN J BATTERSBY JR.
Title or Position: OWNER
Credential: M.D
Phone: 252-635-1788