# COASTAL ORTHOPAEDICS AND SPORTS MEDICINE

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1013969260
- **Authorized official:** PETER DAVID CANDELORA MD (PRACTICE OWNER)
- **Authorized official phone:** (727) 848-1417

## Contact information

- **Practice address:** 5145 DEER PARK DR, NEW PORT RICHEY, FL 34653-7013
- **Practice address phone:** (727) 848-1417
- **Practice address fax:** (727) 847-7526
- **Mailing address:** 5145 DEER PARK DRIVE, NEW PORT RICHEY, FL 34653
- **Mailing address phone:** (727) 848-1417
- **Mailing address fax:** (727) 847-7526

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207X00000X | Orthopaedic Surgery Physician | — | NULL | Yes |
| 207X00000X | Orthopaedic Surgery Physician | — | — | Yes |

## Other

- **Enumeration date:** 05/16/2006
- **Last updated:** 06/16/2025

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | CD6290 | RAILROAD MEDICARE | — |