NPIMap

Organization Active NPI

Coastal Carolina Otolaryngology Associates,PA

  • Plastic Surgery within the Head & Neck (Otolaryngology) Physician
  • Myrtle Beach, SC
National Provider Identifier
1497717086
Registry record updated Sep 10, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Plastic Surgery within the Head & Neck (Otolaryngology) PhysicianTaxonomy code 207YX0007X
Legal business name
COASTAL CAROLINA OTOLARYNGOLOGY ASSOCIATES,PA
Practice address
3822 Mayfair St
Myrtle Beach, SC 29577-0912
Phone
(843) 449-6449
Fax
(843) 449-1069
NPI assigned
Apr 6, 2006
Last updated
Sep 10, 2026By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 10, 2026

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

Authorized official

Name
Mr. Daniel L Rosner, MDNPI 1124087101
Title
Vice President
Phone
(843) 449-6449

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Otolaryngology Physician 207Y00000X NU
Plastic Surgery within the Head & Neck (Otolaryngology) Physician 207YX0007X NU Primary

Addresses

Primary practice location

3822 Mayfair St
Myrtle Beach, SC 29577-0912

Mailing address

3822 Mayfair St
Myrtle Beach, SC 29577-0912
Phone (843) 449-6449

Other practice location 1

1120 Glenns Bay Rd Ste 117
Surfside Beach, SC 29575-4757
Phone (843) 215-1068

Other identifiers 1

IdentifierTypeStateIssuer
GP0566MedicaidSC

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in SC

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20090126000382 SC Part B Supplier - Clinic/Group Practice 4981768645 Receives reassigned benefits from 8 practitioners
Practice locations: Myrtle Beach, SC

National Provider Directory

National Provider Directory

Locations

1021 Cipriana Dr
Ste 220
Myrtle Beach, SC 29572
Phone (843) 449-6449

3822 Mayfair St
Myrtle Beach, SC 29577
Phone (843) 449-6449

Practitioners & affiliated clinicians

Practitioners 12

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1144281600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1788998400000",
    "number": "1497717086",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3822 MAYFAIR ST",
            "city": "MYRTLE BEACH",
            "state": "SC",
            "postal_code": "295770912",
            "telephone_number": "843-449-6449",
            "fax_number": "843-449-1069"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3822 MAYFAIR ST",
            "city": "MYRTLE BEACH",
            "state": "SC",
            "postal_code": "295770912",
            "telephone_number": "843-449-6449",
            "fax_number": "843-449-1069"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1120 Glenns Bay Rd Ste 117",
            "address_purpose": "LOCATION",
            "city": "Surfside Beach",
            "state": "SC",
            "postal_code": "295754757",
            "country_code": "US",
            "telephone_number": "843-215-1068",
            "fax_number": "843-215-1074",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "COASTAL CAROLINA OTOLARYNGOLOGY ASSOCIATES,PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-04-06",
        "last_updated": "2026-09-10",
        "certification_date": "2026-09-10",
        "status": "A",
        "authorized_official_last_name": "ROSNER",
        "authorized_official_first_name": "DANIEL",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "VICE PRESIDENT",
        "authorized_official_telephone_number": "843-449-6449",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207Y00000X",
            "taxonomy_group": "",
            "desc": "Otolaryngology",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207YX0007X",
            "taxonomy_group": "",
            "desc": "Otolaryngology, Plastic Surgery within the Head & Neck",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GP0566",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Myrtle Beach, SC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 10, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.