Basic Information
| Provider Information | |||||||||
| NPI: | 1578861464 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | COASTAL ORTHOPAEDICS-SPN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 235 HANOVER ST | ||||||||
| Address2: | |||||||||
| City: | FALL RIVER | ||||||||
| State: | MA | ||||||||
| PostalCode: | 027205246 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5086469525 | ||||||||
| FaxNumber: | 5086797177 | ||||||||
| Practice Location | |||||||||
| Address1: | 235 HANOVER ST | ||||||||
| Address2: | |||||||||
| City: | FALL RIVER | ||||||||
| State: | MA | ||||||||
| PostalCode: | 027205246 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5086469525 | ||||||||
| FaxNumber: | 5086797177 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/02/2011 | ||||||||
| LastUpdateDate: | 11/13/2014 | ||||||||
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| AuthorizedOfficialLastName: | MABIE | ||||||||
| AuthorizedOfficialFirstName: | KEVIN | ||||||||
| AuthorizedOfficialMiddleName: | N | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 5086469525 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207X00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Orthopaedic Surgery |
No ID Information.