MEDICARE: COASTAL EAR NOSE AND THROAT SURGEONS

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
1	174400000X	Specialist

General Provider Information

NPI Number	:	1497835615
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COASTAL EAR NOSE AND THROAT SURGEONS

Provider Business Mailing Address
First Line	:	984 FIRST COLONIAL RD
Second Line	:	SUITE 302
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23454-3196
Country	:	US
Telephone Number	:	757-481-0385
Fax Number	:	757-481-6946

Provider Business Practice Location Address
First Line	:	984 FIRST COLONIAL RD
Second Line	:	SUITE 302
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23454-3196
Country	:	US
Telephone Number	:	757-481-0385
Fax Number	:	757-481-6946

Authorized Official
Title or Position	:	PRESIDENT
Name	:	RICHARD B ABRISS
Credential	:	M.D.
Telephone Number	:	757-481-0385

Provider Enumeration Date	:	10/16/2006
Last Update Date	:	08/22/2020

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