Organization
COASTAL MEDICAL INC
Active
Other names
COASTAL MEDICAL LAB
Organization subpart
No
Provider details
NPI number
Authorized official
MERYL MOSS (COO)
(401) 421-4000
Entity
Organization
Contact information
Practice address
272 W EXCHANGE ST, SUITE 100, PROVIDENCE, RI 02903-1061
(401) 421-5434
(401) 421-4633
Mailing address
10 DAVOL SQ, SUITE 400, PROVIDENCE, RI 02903-4754
(401) 421-4000
(401) 272-1456
Taxonomy
Speciality
Code
Description
License number
State
291U00000X
Clinical Medical Laboratory
Primary
00412
RI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1972590
—
RI
Enumeration date
09/29/2005
Last updated
02/06/2017
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