Organization
COASTAL PULMONARY MEDICINE PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. TRACE GRIFFIN (PRACTICE MANAGER)
(910) 662-8550
Entity
Organization
Contact information
Practice address
1090 MEDICAL CENTER DR, WILMINGTON, NC 28401-7353
(910) 343-3345
(910) 343-1924
Mailing address
1090 MEDICAL CENTER DR, WILMINGTON, NC 28401-7353
(910) 343-3345
(910) 343-1924
Taxonomy
Speciality
Code
Description
License number
State
207RC0200X
Critical Care Medicine (Internal Medicine) Physician
—
NC
207RP1001X
Pulmonary Disease Physician
Primary
—
NC
207RS0012X
Sleep Medicine (Internal Medicine) Physician
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
01272
BCBS NC GROUP NUMBER
NC
05
—
8901272
—
NC
Enumeration date
12/05/2005
Last updated
04/04/2019
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