Coastal Mobile Medical Doctor, PA

Primary specialty

Geriatric Medicine (Family Medicine) PhysicianTaxonomy code 207QG0300X

License

200100829 Issued in NC

Legal business name

COASTAL MOBILE MEDICAL DOCTOR, PA

Practice address

203 Stagecoach Dr
Jacksonville, NC 28546-9617

Phone

(910) 355-6696

Fax

(910) 355-6696

NPI assigned

Aug 7, 2008

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Narender Deivasekhamani Arcot, MD

Title

President and Ceo

Phone

(910) 355-6696

Specialties & licenses 1

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1218067200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1227139200000",
    "number": "1306092549",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "203 STAGECOACH DR",
            "city": "JACKSONVILLE",
            "state": "NC",
            "postal_code": "285469617",
            "telephone_number": "910-355-6696"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "203 STAGECOACH DR",
            "city": "JACKSONVILLE",
            "state": "NC",
            "postal_code": "285469617",
            "telephone_number": "910-355-6696",
            "fax_number": "910-355-6696"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COASTAL MOBILE MEDICAL DOCTOR, PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-08-07",
        "last_updated": "2008-11-20",
        "status": "A",
        "authorized_official_last_name": "ARCOT",
        "authorized_official_first_name": "NARENDER",
        "authorized_official_middle_name": "DEIVASEKHAMANI",
        "authorized_official_title_or_position": "PRESIDENT AND CEO",
        "authorized_official_telephone_number": "910-355-6696",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207QG0300X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine, Geriatric Medicine",
            "state": "NC",
            "license": "200100829",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Geriatric Medicine (Family Medicine) Physician in Jacksonville, NC
• Providers in Jacksonville, NC by specialty
• Geriatric Medicine (Family Medicine) Physician in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 20, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.