Organization
COASTAL MEDICAL ASSOCIATES
Active
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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