Organization
COASTAL ANESTHESIA MEDICAL GROUP, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JOSEPH MAGGIONCALDA MD (PRES)
(843) 692-1721
Entity
Organization
Contact information
Practice address
809 82ND PARKWAY, MYRTLE BEACH, SC 29572-4607
(843) 692-1062
Mailing address
PO BOX 1792, COLUMBIA, SC 29202-1792
(843) 692-1721
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
GP3330
—
SC
Enumeration date
06/01/2006
Last updated
09/13/2007
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