Healthcare Provider Details

I. General information

NPI: 1023157575
Provider Name (Legal Business Name): COASTAL VASCULAR & VEIN CENTER PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/05/2007
Last Update Date: 07/31/2026
Certification Date: 07/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1327 ASHLEY RIVER RD
CHARLESTON SC
29407-5384
US

IV. Provider business mailing address

8135 FOREST LN # 515057
DALLAS TX
75230-2472
US

V. Phone/Fax

Practice location:
  • Phone: 843-577-4551
  • Fax: 843-577-2227
Mailing address:
  • Phone: 843-577-4551
  • Fax: 843-577-2227

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number State

VIII. Authorized Official

Name: JARYD STEIN
Title or Position: CMO
Credential:
Phone: 213-392-4976