Healthcare Provider Details

I. General information

NPI: 1912082561
Provider Name (Legal Business Name): COASTAL MEDICAL INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/25/2006
Last Update Date: 02/17/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 WARREN AVE SUITE 100
EAST PROVIDENCE RI
02914-1430
US

IV. Provider business mailing address

10 DAVOL SQUARE SUITE 400
PROVIDENCE RI
02903
US

V. Phone/Fax

Practice location:
  • Phone: 401-383-9662
  • Fax: 401-383-6526
Mailing address:
  • Phone: 401-421-4000
  • Fax: 401-272-1456

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RM1200X
TaxonomyMagnetic Resonance Imaging (MRI) Internal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2085B0100X
TaxonomyBody Imaging Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number State

VIII. Authorized Official

Name: MRS. MERYL MOSS
Title or Position: COO
Credential:
Phone: 401-421-4000