Provider Demographics
NPI:1851310890
Name:COASTAL RHEUMATOLOGY PC INC
Entity type:Organization
Organization Name:COASTAL RHEUMATOLOGY PC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:A
Authorized Official - Last Name:D'ARCY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:401-348-2180
Mailing Address - Street 1:45 WELLS STREET
Mailing Address - Street 2:SUITE 203B
Mailing Address - City:WESTERLY
Mailing Address - State:RI
Mailing Address - Zip Code:02891
Mailing Address - Country:US
Mailing Address - Phone:401-348-2180
Mailing Address - Fax:401-348-6298
Practice Address - Street 1:45 WELLS STREET
Practice Address - Street 2:SUITE 203B
Practice Address - City:WESTERLY
Practice Address - State:RI
Practice Address - Zip Code:02891
Practice Address - Country:US
Practice Address - Phone:401-348-2180
Practice Address - Fax:401-348-6298
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-19
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT3926207RR0500X
RIMD10874207RR0500X
RIMD10564207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
RIGROUPCR40894Medicaid
RIID#60388Medicare UPIN
RI660000033Medicare PIN
RI438872Medicare UPIN
RI007057165Medicare PIN
RI007057164Medicare PIN
RIGROUPCR40894Medicaid