Provider Demographics
NPI:1528487683
Name:COASTAL DERM & COSMETIC CENTER, INC
Entity type:Organization
Organization Name:COASTAL DERM & COSMETIC CENTER, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:HUA
Authorized Official - Middle Name:
Authorized Official - Last Name:ZHOU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:401-490-4515
Mailing Address - Street 1:1539 ATWOOD AVE
Mailing Address - Street 2:SUITE 301
Mailing Address - City:JOHNSTON
Mailing Address - State:RI
Mailing Address - Zip Code:02919-3262
Mailing Address - Country:US
Mailing Address - Phone:401-490-4515
Mailing Address - Fax:401-490-4516
Practice Address - Street 1:1539 ATWOOD AVE
Practice Address - Street 2:SUITE 301
Practice Address - City:JOHNSTON
Practice Address - State:RI
Practice Address - Zip Code:02919-3262
Practice Address - Country:US
Practice Address - Phone:401-490-4515
Practice Address - Fax:401-490-4516
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-15
Last Update Date:2024-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty