Coastal Pediatric Associates, PLLC

Primary specialty

SpecialistTaxonomy code 174400000X

License

17469 Issued in NC

Legal business name

COASTAL PEDIATRIC ASSOCIATES, PLLC

Practice address

3505 Converse Dr
Suite 200
Wilmington, NC 28403-6131

Phone

(910) 392-5634

Fax

(910) 777-2022

NPI assigned

May 12, 2015

Organization subpart

No

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

Authorized official

Name

Dr. Thomas Blackstone, M.D.

Title

Managing Member

Phone

(910) 202-8020

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1431388800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1431388800000",
    "number": "1447638341",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3505 CONVERSE DR",
            "address_2": "SUITE 200",
            "city": "WILMINGTON",
            "state": "NC",
            "postal_code": "284036131",
            "telephone_number": "910-392-5634",
            "fax_number": "910-777-2022"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3505 CONVERSE DR",
            "address_2": "SUITE 200",
            "city": "WILMINGTON",
            "state": "NC",
            "postal_code": "284036131",
            "telephone_number": "910-392-5634",
            "fax_number": "910-777-2022"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COASTAL PEDIATRIC ASSOCIATES, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-05-12",
        "last_updated": "2015-05-12",
        "status": "A",
        "authorized_official_last_name": "BLACKSTONE",
        "authorized_official_first_name": "THOMAS",
        "authorized_official_title_or_position": "MANAGING MEMBER",
        "authorized_official_telephone_number": "910-202-8020",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Specialist",
            "state": "NC",
            "license": "17469",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Coastal Nutrition, LLC
• Coastal Occupational Therapy
• Coastal Optical of Wilmington
• Coastal Optical Services of Wilmington
• Coastal Optical, Inc.
• Coastal Pharmacy and Compounding
• Coastal Physical Therapy
• Coastal Pulmonary Medicine PA
• Coastal Rehabilitation Associates
• Coastal Rehabilition Associates

• Specialist in Wilmington, NC
• Providers in Wilmington, NC by specialty
• Specialist in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 12, 2015; 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.