Organization
INTRACOASTAL INTERNAL MEDICINE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY DAHLSTROM (ADMIN ASST)
(910) 332-0701
Entity
Organization
Contact information
Practice address
2580 PICKARD RD, WILMINGTON, NC 28403-4461
(910) 332-0701
(910) 332-0710
Mailing address
2580 PICKARD RD, WILMINGTON, NC 28403-4461
(910) 332-0701
(910) 332-0710
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1447204631
—
NC
05
—
1467917880
—
NC
05
—
5903216
—
NC
05
—
7005481
—
NC
05
—
7005555
—
NC
05
—
891069V
—
NC
05
—
8911484
—
NC
Enumeration date
07/07/2006
Last updated
06/19/2019
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