Organization
COASTAL CAROLINA RADIOLOGY, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
WILLIAM JEFFERSON BEAVERS M.D. (MEMBER)
(252) 384-4615
Entity
Organization
Contact information
Practice address
1144 N ROAD ST, HWY 17N, ELIZABETH CITY, NC 27909-3353
(252) 384-4615
(252) 384-4684
Mailing address
PO BOX 12017, NEWPORT NEWS, VA 23612-2017
(757) 867-6101
(757) 867-6588
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
019YN
BCBS
NC
05
—
5908639
—
NC
Enumeration date
12/17/2007
Last updated
04/28/2008
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