Organization
COASTAL DERMATOLOGY & SURGERY CENTER, PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
HEATHER A LOESCH MD (OWNER PRESIDENT)
(910) 343-0626
Entity
Organization
Contact information
Practice address
2504 DELANEY AVENUE, WILMINGTON, NC 28403-6002
(910) 343-0626
(910) 343-8012
Mailing address
2504 DELANEY AVE, WILMINGTON, NC 28403-6002
(910) 343-0626
(910) 343-8012
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
200000526
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
89126AC
—
NC
Enumeration date
04/17/2007
Last updated
03/13/2013
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