Organization
EXTENDED CARE PHYSICIANS - COASTAL, PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ROBIN GLEESON-WARREN (DIRECTOR OF CREDENTIALING)
(828) 210-2678
Entity
Organization
Contact information
Practice address
1013 PORTERS NECK RD, SUITE 130, WILMINGTON, NC 28411-8130
(910) 795-1471
Mailing address
PO BOX 890194, CHARLOTTE, NC 28289-0194
Taxonomy
Speciality
Code
Description
License number
State
207QG0300X
Geriatric Medicine (Family Medicine) Physician
Primary
—
—
207QH0002X
Hospice and Palliative Medicine (Family Medicine) Physician
—
—
207RG0300X
Geriatric Medicine (Internal Medicine) Physician
—
—
207RH0002X
Hospice and Palliative Medicine (Internal Medicine) Physician
—
—
2084P0805X
Geriatric Psychiatry Physician
—
—
363LF0000X
Family Nurse Practitioner
—
—
363LG0600X
Gerontology Nurse Practitioner
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
5918852
—
NC
Enumeration date
04/16/2008
Last updated
03/19/2014
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