MEDICARE: COASTAL CONCIERGE MEDICINE AND AESTHETICS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	207P00000X	Emergency Medicine Physician
2	207QA0401X	Addiction Medicine (Family Medicine) Physician
3	261QU0200X	Urgent Care Clinic/Center
4	207Q00000X	Family Medicine Physician

General Provider Information

NPI Number	:	1104393214
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COASTAL CONCIERGE MEDICINE AND AESTHETICS

Provider Business Mailing Address
First Line	:	4420 OLEANDER DR STE 101
Second Line	:
City	:	MYRTLE BEACH
State	:	SC
Zip	:	29577-5720
Country	:	US
Telephone Number	:	843-491-3007
Fax Number	:	888-895-4537

Provider Business Practice Location Address
First Line	:	802 41ST AVE S
Second Line	:
City	:	NORTH MYRTLE BEACH
State	:	SC
Zip	:	29582-5155
Country	:	US
Telephone Number	:	843-491-3007
Fax Number	:	888-895-4537

Authorized Official
Title or Position	:	PHYSICIAN OWNER
Name	:	DR. DAVID WEITZMAN
Credential	:	MD
Telephone Number	:	843-491-3007

Provider Enumeration Date	:	10/26/2018
Last Update Date	:	05/05/2022

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Directions to “COASTAL CONCIERGE MEDICINE AND AESTHETICS ” Practice Location

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