Organization
COASTAL VASCULAR INSTITUTE, PA
Active
Other names
Coastal Carolina Surgical Associates, PA
Organization subpart
No
Provider details
NPI number
Authorized official
KARA FLORENCE MARCUSSEN (CEO)
(910) 343-0811
Entity
Organization
Contact information
Practice address
1411 PHYSICIANS DRIVE, WILMINGTON, NC 28401-7338
(910) 343-0811
(910) 343-5719
Mailing address
1411 PHYSICIANS DRIVE, WILMINGTON, NC 28401-7338
(910) 343-0811
(910) 343-5719
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
40958
NC
208600000X
Surgery Physician
CERTIFICATE # 40958
NC
2086S0129X
Vascular Surgery Physician
40958
NC
2086S0129X
Vascular Surgery Physician
Primary
CERTIFICATE # 40958
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0271C
BCBS OF NC GROUP #
NC
01
—
142384
GRP UNITED HEALTHCARE #
NC
05
—
79-0271C
—
NC
01
—
CB0557
RAILROAD MEDICARE GROUP #
NC
Enumeration date
10/02/2006
Last updated
04/25/2023
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