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General NPI Number Information
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NPI Number | 1558628883
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Entity Type | Organization
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Legal Business Name | COASTAL WOMENS CARE PC
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Dates
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Enumeration Date | 04/11/2012
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Last Update Date | 04/11/2012
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Provider Practice Location Address
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Address Line | 1721 ALLENS LN SUITE 102
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City | WILMINGTON
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State | NC
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Zip | 28403-3661
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Country | US
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Telephone | 910-620-1053
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Fax |
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Provider Business Mailing Address
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Address Line | 1721 ALLENS LN SUITE 102
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City | WILMINGTON
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State | NC
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Zip | 28403-3661
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Country | US
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Telephone | 910-620-1053
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Fax |
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Authorized Official
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Title or Position | PHYSICIAN
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Name | DR. FAZIL A MOHAMED II
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Credential | MD
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Telephone | 910-620-1053
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207VG0400X
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Taxonomy Name | Gynecology Physician
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License Number | 201001263
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License Number State | NC
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