Healthcare Provider Details

I. General information

NPI: 1164448130
Provider Name (Legal Business Name): COASTAL CAROLINA RADIATION ONCOLOGY, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/14/2006
Last Update Date: 12/03/2024
Certification Date: 12/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1988 S 16TH ST
WILMINGTON NC
28401-6647
US

IV. Provider business mailing address

PO BOX 4574
WILMINGTON NC
28406-1574
US

V. Phone/Fax

Practice location:
  • Phone: 910-662-8440
  • Fax: 910-795-4826
Mailing address:
  • Phone: 910-251-1839
  • Fax: 910-251-8286

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QX0203X
TaxonomyRadiation Oncology Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: PATRICK DAVID MAGUIRE
Title or Position: PRESIDENT
Credential: MD
Phone: 910-662-8440