Organization
COASTAL CHILDRENS CLINIC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DIANE HOUCK (PRACTICE ADMINISTRATOR)
(252) 633-2900
Entity
Organization
Contact information
Practice address
1004 JENKINS AVENUE, MAYSVILLE, NC 28555
(252) 633-2900
Mailing address
703 NEWMAN RD, NEW BERN, NC 28562-5239
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
8901346
—
NC
Enumeration date
07/02/2008
Last updated
07/02/2008
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