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General NPI Number Information
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NPI Number | 1487835435
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Entity Type | Organization
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Legal Business Name | COASTAL UROLOGY, P.C.
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Dates
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Enumeration Date | 11/19/2007
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Last Update Date | 11/19/2007
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Provider Practice Location Address
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Address Line | 1856 COLONIAL MEDICAL CT STE B
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City | VIRGINIA BEACH
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State | VA
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Zip | 23454-3075
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Country | US
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Telephone | 757-481-9009
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Fax | 757-481-9401
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Provider Business Mailing Address
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Address Line | 1856 COLONIAL MEDICAL CT STE B
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City | VIRGINIA BEACH
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State | VA
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Zip | 23454-3075
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Country | US
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Telephone | 757-481-9009
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Fax | 757-481-9401
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. B. WARREN PECHAN
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Credential | M.D.
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Telephone | 757-481-9009
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 01011031873
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License Number State | VA
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