Provider Demographics
NPI:1578861464
Name:COASTAL ORTHOPAEDICS-SPN
Entity type:Organization
Organization Name:COASTAL ORTHOPAEDICS-SPN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:N
Authorized Official - Last Name:MABIE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:508-646-9525
Mailing Address - Street 1:235 HANOVER ST
Mailing Address - Street 2:
Mailing Address - City:FALL RIVER
Mailing Address - State:MA
Mailing Address - Zip Code:02720-5246
Mailing Address - Country:US
Mailing Address - Phone:508-646-9525
Mailing Address - Fax:508-679-7177
Practice Address - Street 1:235 HANOVER ST
Practice Address - Street 2:
Practice Address - City:FALL RIVER
Practice Address - State:MA
Practice Address - Zip Code:02720-5246
Practice Address - Country:US
Practice Address - Phone:508-646-9525
Practice Address - Fax:508-679-7177
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-02
Last Update Date:2014-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAM15917Medicare PIN
MA110072082AMedicaid