Healthcare Provider Details

I. General information

NPI: 1700796869
Provider Name (Legal Business Name): COASTAL SPINE & SPORTS MEDICINE, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/10/2026
Last Update Date: 09/10/2026
Certification Date: 09/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1209 CULBRETH DR STE 102
WILMINGTON NC
28405-8318
US

IV. Provider business mailing address

1209 CULBRETH DR STE 102
WILMINGTON NC
28405-8318
US

V. Phone/Fax

Practice location:
  • Phone: 910-834-8850
  • Fax: 910-319-8851
Mailing address:
  • Phone: 910-834-8850
  • Fax: 910-319-8851

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: FRANCIS SALVOTORE PECORARO
Title or Position: MEMBER/MANAGER
Credential:
Phone: 910-834-8850