Organization
COASTAL VASCULAR INSTITUTE, PA
Active
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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