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General NPI Number Information
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NPI Number | 1912077090
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Entity Type | Organization
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Legal Business Name | COASTAL ONCOLOGY & HEMATOLOGY PA
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Dates
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Enumeration Date | 11/08/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 3322 WELLONS BLVD
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City | NEW BERN
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State | NC
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Zip | 28562-5290
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Country | US
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Telephone | 252-634-1616
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Fax | 252-634-1617
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Provider Business Mailing Address
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Address Line | 3322 WELLONS BLVD
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City | NEW BERN
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State | NC
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Zip | 28562-5290
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Country | US
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Telephone | 252-634-1616
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Fax | 252-634-1617
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. ANNA G FAIDAS
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Credential | MD
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Telephone | 252-634-1616
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RH0003X
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Taxonomy Name | Hematology & Oncology Physician
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License Number | 9601134
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License Number State | NC
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