Provider Demographics
NPI:1528154473
Name:COASTAL INFECTIOUS DISEASE CONSULTANTS
Entity type:Organization
Organization Name:COASTAL INFECTIOUS DISEASE CONSULTANTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AMAN
Authorized Official - Middle Name:J
Authorized Official - Last Name:PATHAK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:910-763-4511
Mailing Address - Street 1:2310 DELANEY RD
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28403-6013
Mailing Address - Country:US
Mailing Address - Phone:910-763-4511
Mailing Address - Fax:910-763-6608
Practice Address - Street 1:2310 DELANEY RD
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28403-6013
Practice Address - Country:US
Practice Address - Phone:910-763-4511
Practice Address - Fax:910-763-6608
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-05
Last Update Date:2024-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC018HCOtherBCBSNC PROVIDER
NC5902944Medicaid
NC2330341Medicare ID - Type Unspecified