=====================================================
General NPI Number Information
=====================================================
NPI Number | 1689628448
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | COASTAL ORTHOPEDICS, PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/19/2006
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 297 NORTH ST SUITE 6A
-----------------------------------------------------
City | HYANNIS
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 02601-5108
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 508-862-2663
-----------------------------------------------------
Fax | 508-771-7293
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 297 NORTH ST SUITE 6A
-----------------------------------------------------
City | HYANNIS
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 02601-5108
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 508-862-2663
-----------------------------------------------------
Fax | 508-771-7293
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER PRESIDENT
-----------------------------------------------------
Name | DR. PAUL R BENOIT
-----------------------------------------------------
Credential | M.D
-----------------------------------------------------
Telephone | 508-862-2663
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 174400000X
-----------------------------------------------------
Taxonomy Name | Specialist
-----------------------------------------------------
License Number | 79725
-----------------------------------------------------
License Number State | MA
-----------------------------------------------------