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General NPI Number Information
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NPI Number | 1154693703
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Entity Type | Organization
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Legal Business Name | COASTAL TESTING
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Dates
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Enumeration Date | 01/29/2012
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Last Update Date | 01/29/2012
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Provider Practice Location Address
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Address Line | 316 US ROUTE 1 SUITE G
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City | YORK
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State | ME
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Zip | 03909-1673
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Country | US
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Telephone | 207-363-0391
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Fax |
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Provider Business Mailing Address
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Address Line | 316 US ROUTE 1
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City | YORK
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State | ME
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Zip | 03909-1673
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Country | US
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Telephone | 207-363-0391
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MICHAEL TETREAULT
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Credential |
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Telephone | 207-363-0391
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 291U00000X
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Taxonomy Name | Clinical Medical Laboratory
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License Number |
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License Number State |
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