Provider Demographics
NPI:1124176664
Name:COIN, JAMES THADDEUS (MD)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:THADDEUS
Last Name:COIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3098
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28406-0098
Mailing Address - Country:US
Mailing Address - Phone:910-762-9131
Mailing Address - Fax:910-762-1281
Practice Address - Street 1:2515 DELANEY AVE
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28403-6003
Practice Address - Country:US
Practice Address - Phone:910-762-9131
Practice Address - Fax:910-762-1281
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-08
Last Update Date:2012-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC298142084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC23534OtherBCBS
NC7923534Medicaid
205505JMedicare PIN
NC23534OtherBCBS