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General NPI Number Information
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NPI Number | 1770700759
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Entity Type | Organization
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Legal Business Name | COASTAL PEDIATRIC ASSOCIATES, P.A.
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Dates
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Enumeration Date | 04/19/2007
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Last Update Date | 08/02/2022
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Provider Practice Location Address
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Address Line | 2067 CHARLIE HALL BLVD
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City | CHARLESTON
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State | SC
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Zip | 29414-5834
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Country | US
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Telephone | 843-573-2535
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Fax | 843-573-2534
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Provider Business Mailing Address
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Address Line | 4975 LACROSS RD STE 150
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City | NORTH CHARLESTON
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State | SC
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Zip | 29406-6531
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PARTNER
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Name | DR. ROBERT ANDREW CLIFFORD
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Credential | M.D.
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Telephone | 843-573-2535
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TH0100X
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Taxonomy Name | Health Service Psychologist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number |
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License Number State |
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