# COASTAL ANESTHESIA MEDICAL GROUP, LLC

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

## Provider details

- **NPI number:** 1609813179
- **Authorized official:** DR. JOSEPH MAGGIONCALDA MD (PRES)
- **Authorized official phone:** (843) 692-1721

## Contact information

- **Practice address:** 809 82ND PARKWAY, MYRTLE BEACH, SC 29572-4607
- **Practice address phone:** (843) 692-1062
- **Mailing address:** PO BOX 1792, COLUMBIA, SC 29202-1792
- **Mailing address phone:** (843) 692-1721

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207L00000X | Anesthesiology Physician | — | NULL | Yes |
| 207L00000X | Anesthesiology Physician | — | — | Yes |

## Other

- **Enumeration date:** 06/01/2006
- **Last updated:** 09/13/2007

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | GP3330 | — | SC |