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General NPI Number Information
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NPI Number | 1043312515
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Entity Type | Organization
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Legal Business Name | COASTAL GASTROENTEROLOGY ASSOCIATES, PA
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Dates
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Enumeration Date | 09/03/2006
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Last Update Date | 06/02/2014
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Provider Practice Location Address
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Address Line | 1015 MEDICAL CENTER BLVD SUITE 1300
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City | WEBSTER
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State | TX
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Zip | 77598-4052
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Country | US
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Telephone | 281-557-2527
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Fax | 281-557-7203
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Provider Business Mailing Address
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Address Line | 1015 MEDICAL CENTER BLVD SUITE 1300
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City | WEBSTER
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State | TX
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Zip | 77598-4052
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Country | US
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Telephone | 281-557-2527
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Fax | 281-557-7203
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. KALYANAM SUBRAMANYAM
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Credential | M.D.
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Telephone | 281-557-2527
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RG0100X
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Taxonomy Name | Gastroenterology Physician
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License Number |
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License Number State |
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