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NPI Code Detail

MEDICARE: COASTAL UROLOGY, P.C.

MEDICARE: COASTAL UROLOGY, P.C.
Medicare Provider Information

Scope of Practice

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

# Taxonomy Code Taxonomy License Number License Number State
1174400000XSpecialist01011031873VA

General Provider Information

NPI Number : 1487835435
Entity Type Code : Organization
Provider Name (Legal Business Name) : COASTAL UROLOGY, P.C.
Provider Business Mailing Address
First Line : 1856 COLONIAL MEDICAL CT STE B
Second Line :
City : VIRGINIA BEACH
State : VA
Zip : 23454-3075
Country : US
Telephone Number : 757-481-9009
Fax Number : 757-481-9401
Provider Business Practice Location Address
First Line : 1856 COLONIAL MEDICAL CT STE B
Second Line :
City : VIRGINIA BEACH
State : VA
Zip : 23454-3075
Country : US
Telephone Number : 757-481-9009
Fax Number : 757-481-9401
Authorized Official
Title or Position : PRESIDENT
Name : DR. B. WARREN PECHAN
Credential : M.D.
Telephone Number : 757-481-9009
Provider Enumeration Date : 11/19/2007
Last Update Date : 11/19/2007

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