=====================================================
General NPI Number Information
=====================================================
NPI Number | 1093678104
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | COASTAL MEDICAL PHYSICIANS, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/05/2025
-----------------------------------------------------
Last Update Date | 12/05/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 375 WAMPANOAG TRL
-----------------------------------------------------
City | RIVERSIDE
-----------------------------------------------------
State | RI
-----------------------------------------------------
Zip | 02915-2232
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 401-649-4000
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 15 LA SALLE SQ
-----------------------------------------------------
City | PROVIDENCE
-----------------------------------------------------
State | RI
-----------------------------------------------------
Zip | 02903-1814
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 401-649-4000
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | VP REVENUE CYCLE
-----------------------------------------------------
Name | CHRISTINE RAWNSLEY
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 401-444-6905
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207R00000X
-----------------------------------------------------
Taxonomy Name | Internal Medicine Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------