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General NPI Number Information
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NPI Number | 1720128044
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Entity Type | Organization
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Legal Business Name | COASTAL CAROLINA ANESTHESIOLOGIST, P.A.
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Dates
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Enumeration Date | 02/07/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 500 JEFFERSON ST
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City | WHITEVILLE
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State | NC
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Zip | 28472-3634
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Country | US
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Telephone | 910-642-6427
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Fax | 910-642-5769
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Provider Business Mailing Address
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Address Line | PO BOX 505
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City | WHITEVILLE
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State | NC
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Zip | 28472-0505
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Country | US
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Telephone | 910-642-6427
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Fax | 910-642-5769
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. ROBIN ZAKI DIMITRIOUS
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Credential | M.D.
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Telephone | 910-642-6427
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number |
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License Number State | NC
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