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General NPI Number Information
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NPI Number | 1275052755
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Entity Type | Organization
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Legal Business Name | COASTAL FOOT & ANKLE INC
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Dates
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Enumeration Date | 09/15/2017
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 850 AQUIDNECK AVE
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City | MIDDLETOWN
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State | RI
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Zip | 02842-7280
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Country | US
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Telephone | 401-849-2157
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Fax | 401-848-8441
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Provider Business Mailing Address
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Address Line | 850 AQUIDNECK AVE
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City | MIDDLETOWN
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State | RI
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Zip | 02842-7280
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Country | US
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Telephone | 401-849-2157
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Fax | 401-848-8441
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Authorized Official
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Title or Position | OWNER
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Name | JONATHAN SABOURIN
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Credential | DPM
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Telephone | 508-258-1717
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number | 2210
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License Number State | MA
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Taxonomy #2
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Taxonomy Code | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number | DPM00316
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License Number State | RI
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