# COASTAL PEDIATRIC ASSOCIATES, P.A.

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

## Provider details

- **NPI number:** 1770700759
- **Authorized official:** DR. ROBERT ANDREW CLIFFORD M.D. (PARTNER)
- **Authorized official phone:** (843) 573-2535

## Contact information

- **Practice address:** 2067 CHARLIE HALL BLVD, CHARLESTON, SC 29414-5834
- **Practice address phone:** (843) 573-2535
- **Practice address fax:** (843) 573-2534
- **Mailing address:** 4975 LACROSS RD STE 150, NORTH CHARLESTON, SC 29406-6531

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 103TH0100X | Health Service Psychologist | — | NULL | — |
| 103TH0100X | Health Service Psychologist | — | — | — |
| 208000000X | Pediatrics Physician | — | NULL | Yes |
| 208000000X | Pediatrics Physician | — | — | Yes |

## Other

- **Enumeration date:** 04/19/2007
- **Last updated:** 08/02/2022

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | GP4680 | — | SC |
| 05 | — | GP4716 | — | SC |
| 05 | — | GP7882 | — | SC |
| 05 | — | GP8203 | — | SC |
| 05 | — | GP8228 | — | SC |
| 05 | — | GP8229 | — | SC |
| 05 | — | GP8237 | — | SC |
| 05 | — | PG1066 | — | SC |