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COASTAL CAROLINA OTOLARYNGOLOGY ASSOCIATESPA NPI 1497717086


NPI Information

NPI: 1497717086
Provider Name: COASTAL CAROLINA OTOLARYNGOLOGY ASSOCIATES,PA
Classification: Otolaryngology - 207YX0007X
Entity Type: Organization

Specialization: Plastic Surgery within the Head & Neck

Address:
3822 MAYFAIR ST
MYRTLE BEACH, SC
ZIP 29577
Phone: (843) 449-6449
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COASTAL CAROLINA OTOLARYNGOLOGY ASSOCIATES,PA is a plastic surgery within the head and neck otolaryngology in Myrtle Beach, SC. The provider is an otolaryngologist with additional training in plastic and reconstructive procedures within the head, face, neck and associated structures, including cutaneous head and neck oncology and reconstruction, management of maxillofacial trauma, soft tissue repair and neural surgery. The field is diverse and involves a wide age range of patients, from the newborn to the aged. While both cosmetic and reconstructive surgeries are practiced, there are many additional procedures which interface with them. COASTAL CAROLINA OTOLARYNGOLOGY ASSOCIATES,PA NPI is 1497717086. The provider is registered as an organization entity type and is a multi-specialty group.

The provider's business location address is:

3822 MAYFAIR ST
MYRTLE BEACH, SC
ZIP 29577-912
Phone: (843) 449-6449
Fax: (843) 449-1069

The provider's authorized official is Daniel L Rosner .
The authorized official title is Vice President and has the following contact phone number (843) 449-6449.

The enumeration date for this NPI number is 4/6/2006 and was last updated on 1/4/2024.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.Taxonomy CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
1207Y00000XOtolaryngologyNo
2207YX0007XOtolaryngologyPlastic Surgery within the Head & NeckYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.Other Provider IdentifierOther Provider Identifier TypeOther Provider Identifier StateOther Provider Identifier Issuer
1GP0566MEDICAIDSOUTH CAROLINA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

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