Organization
COASTAL MEDICAL ASSOCIATES
Active
Other names
Coastal Medical Associates, Inc.
Organization subpart
No
Provider details
NPI number
Authorized official
MARIANNE CAPUTO (PROVIDER ENROLLMENT SUPERVISOR)
(781) 792-4136
Entity
Organization
Contact information
Practice address
55 FOGG RD, WEYMOUTH, MA 02190-2432
(781) 340-4293
(781) 340-3782
Mailing address
55 FOGG RD, WEYMOUTH, MA 02190-2432
(781) 624-8000
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
—
—
207L00000X
Anesthesiology Physician
Primary
—
—
207RA0401X
Addiction Medicine (Internal Medicine) Physician
—
—
367500000X
Certified Registered Nurse Anesthetist
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
9771085
—
MA
Enumeration date
02/23/2006
Last updated
01/23/2024
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