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General NPI Number Information
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NPI Number | 1215242755
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Entity Type | Organization
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Legal Business Name | COASTAL PLASTIC SURGERY LTD
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Dates
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Enumeration Date | 08/09/2010
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Last Update Date | 08/31/2016
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Provider Practice Location Address
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Address Line | 1200 FIRST COLONIAL RD SUITE 100
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City | VIRGINIA BEACH
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State | VA
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Zip | 23454-2274
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Country | US
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Telephone | 757-481-7788
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Fax | 757-481-1707
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Provider Business Mailing Address
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Address Line | 1200 FIRST COLONIAL RD SUITE 100
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City | VIRGINIA BEACH
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State | VA
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Zip | 23454-2274
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Country | US
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Telephone | 757-481-7788
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Fax | 757-481-1707
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. GLENN R. CARWELL JR.
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Credential | M.D.
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Telephone | 757-481-7788
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2086S0105X
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Taxonomy Name | Surgery of the Hand (Surgery) Physician
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License Number | 0101025726
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 2086S0122X
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Taxonomy Name | Plastic and Reconstructive Surgery Physician
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License Number | 0101025726
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License Number State | VA
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