MEDICARE: COASTLINE MEDICAL WALK IN CENTER

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	261QU0200X	Urgent Care Clinic/Center

General Provider Information

NPI Number	:	1710118088
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COASTLINE MEDICAL WALK IN CENTER

Provider Business Mailing Address
First Line	:	611 FEDERAL ST
Second Line	:	SUITE 5
City	:	MILTON
State	:	DE
Zip	:	19968-1157
Country	:	US
Telephone Number	:	302-329-9046
Fax Number	:

Provider Business Practice Location Address
First Line	:	611 FEDERAL ST
Second Line	:	SUITE 5
City	:	MILTON
State	:	DE
Zip	:	19968-1157
Country	:	US
Telephone Number	:	302-329-9046
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. AARON RAYMOND BLOCK
Credential	:	PHYSICIAN ASSISTANT
Telephone Number	:	302-329-9046

Provider Enumeration Date	:	08/04/2009
Last Update Date	:	11/12/2009

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Directions to “COASTLINE MEDICAL WALK IN CENTER ” Practice Location

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