Coastal Dermatology P.C.

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

License

0101241129 Issued in VA

Legal business name

COASTAL DERMATOLOGY P.C.

Practice address

3176 Holland Rd.
103
Virginia Beach, VA 23453

Phone

(757) 368-7546

NPI assigned

Apr 14, 2010

Last updated

Apr 14, 2010By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Kimberly Diane Ingram Soderberg I, M.D.

Title

President

Phone

(757) 368-7546

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in VA

Enrollment records 1

Locations

Practitioners 5

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.

• Kimberly Ingram Soderberg, MD

  • Dermatology Physician
  • Virginia Beach, VA
  • NPI 1386786697
  Medicare reassignment Care Compare group NPD
• Yekaterina V Jones

  • Medical Physician Assistant
  • Virginia Beach, VA
  • NPI 1336775311
  Medicare reassignment Care Compare group
• Meghan Raffo Stufflebeem

  • Physician Assistant
  • Norfolk, VA
  • NPI 1336742477
  Medicare reassignment Care Compare group
• Taylor Randall Watrous

  • Physician Assistant
  • Norfolk, VA
  • NPI 1528473725
  Medicare reassignment Care Compare group
• Meredith Bundy Huffman, PA-C

  • Physician Assistant
  • Virginia Beach, VA
  • NPI 1053674044
  Medicare reassignment

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

{
    "created_epoch": "1271203200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1271203200000",
    "number": "1730405879",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3176 HOLLAND RD.",
            "address_2": "103",
            "city": "VIRGINIA BEACH",
            "state": "VA",
            "postal_code": "23453",
            "telephone_number": "757-368-7546"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3176 HOLLAND RD.",
            "address_2": "103",
            "city": "VIRGINIA BEACH",
            "state": "VA",
            "postal_code": "23453",
            "telephone_number": "757-368-7546"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COASTAL DERMATOLOGY P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-04-14",
        "last_updated": "2010-04-14",
        "status": "A",
        "authorized_official_last_name": "INGRAM SODERBERG",
        "authorized_official_first_name": "KIMBERLY",
        "authorized_official_middle_name": "DIANE",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "757-368-7546",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_name_suffix": "I",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "VA",
            "license": "0101241129",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Coastal Anesthesia ., Inc
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• Coastal Ear Nose and Throat Surgeons
• Coastal Family Practice PC
• Coastal Family Services, Inc. (Visiting Angels of Virginia Beach)
• Coastal Ferry LLC (Coastal Ferry)
• Coastal Hair Restoration, Inc (Coastal Medical Solutions)

• Dermatology Physician in Virginia Beach, VA
• Providers in Virginia Beach, VA by specialty
• Dermatology Physician in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 14, 2010; 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.