1104024728 NPI number — COASTAL ORTHOPAEDICS, PC

Table of content: DR. CANDACE ALENE MCGHEE AUD. (NPI 1104933753)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1104024728 NPI number — COASTAL ORTHOPAEDICS, PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COASTAL ORTHOPAEDICS, PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1104024728
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/15/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
761 MAIN AVE
Provider Second Line Business Mailing Address:
SUITE 115
Provider Business Mailing Address City Name:
NORWALK
Provider Business Mailing Address State Name:
CT
Provider Business Mailing Address Postal Code:
06851-1080
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
203-845-2995
Provider Business Mailing Address Fax Number:
203-847-1940

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
36 OLD KINGS HWY SOUTH
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DARIEN
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06880
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
203-845-2995
Provider Business Practice Location Address Fax Number:
203-847-1940
Provider Enumeration Date:
07/05/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
FRYDRYCH
Authorized Official First Name:
DONNA
Authorized Official Middle Name:
Authorized Official Title or Position:
EXECUTIVE ASSISTANT
Authorized Official Telephone Number:
203-845-2995

Provider Taxonomy Codes

  • Taxonomy code: 207XS0106X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207XS0114X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207XS0117X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207XX0004X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207XX0005X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207XX0801X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2081P2900X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 225X00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 225XH1200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207XP3100X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207X00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: C02816 . This is a "MEDICARE ID" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".