COASTAL CAROLINA OTOLARYNGOLOGY ASSOCIATES,PA (NPI# 1497717086) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1497717086 |
| Entity Type | Organization |
| Organization Name | COASTAL CAROLINA OTOLARYNGOLOGY ASSOCIATES,PA |
| Practice Address |
1021 Cipriana Dr Ste 220 Myrtle Beach SC 29572-4621 |
| Practice Telephone | 8434496449 |
| Practice Fax Number | 8434491069 |
| Mailing Telephone | 8434496449 |
| Mailing Fax Number | 8434491069 |
| Enumeration Date | 2006-04-06 |
| Last Update Date | 2013-05-29 |
| Authorized Official Name | MR. DANIEL L ROSNER (VICE PRESIDENT) |
| Authorized Official Telephone | 8434496449 |
| Authorized Official Credential | MD |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 207Y00000X | Otolaryngology | Allopathic & Osteopathic Physicians | ||
| Y | 207YX0007X |
Otolaryngology Specialization: Plastic Surgery within the Head & Neck |
Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| SC | GP0566 | 05 |
| Street Address |
1021 CIPRIANA DR STE 220 |
| City | MYRTLE BEACH |
| State | SC |
| Zip Code | 29572-4621 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1972128072 | Conner Noelle Rouch | Audiologist-Hearing Aid Fitter | 1021 Cipriana Dr Ste 220, Myrtle Beach, SC 29572-4621 | 2020-06-15 |
| 1053675819 | Sheila Putman | Otolaryngology | 1021 Cipriana Dr Ste 220, Myrtle Beach, SC 29572-4621 | 2012-06-26 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1629684576 | Matthew David Zeuschner | Nurse Practitioner | 107 Woodwind Court, Myrtle Beach, SC 29572 | 2020-09-16 |
| 1578191789 | Julia Ruth Nelson | Student in an Organized Health Care Education/Training Program | Grand Strand Medical Center- Gme Office, 809 82nd Parkway, Myrtle Beach, SC 29572 | 2020-04-01 |
| 1407484835 | Justin Schevers | Student in an Organized Health Care Education/Training Program | 802 82nd Parkway, Myrtle Beach, SC 29572 | 2020-03-31 |
| 1922636919 | Darian Michael Quigg | Student in an Organized Health Care Education/Training Program | 809 82nd Street Parkway, Myrtle Beach, SC 29572 | 2020-03-27 |
| 1881221141 | Jonathan Alden Bryan | Student in an Organized Health Care Education/Training Program | Grand Strand Medical Center, 809 82nd Parkway, Myrtle Beach, SC 29572 | 2020-03-26 |
| 1215575238 | Polaris Skin Diagnostics, LLC | Dermatology | 8170 Rourk Street, Suite 100, Myrtle Beach, SC 29572 | 2019-12-20 |
| 1700348711 | Five Star Rehabilitation and Wellness Services, LLC. | Clinic/Center | 9547 N Kings Hwy, Myrtle Beach, SC 29572 | 2019-04-01 |
| 1154882975 | Michael Kouandjio | Student in an Organized Health Care Education/Training Program | Grand Strand Medical Center-gme Office, 809 82nd Parkway, Myrtle Beach, SC 29572 | 2019-03-26 |
| 1154880102 | Dylan Chase Morgan | Internal Medicine | Grand Strand Medical Center - Gme Office, 809 82nd Pkwy, Myrtle Beach, SC 29572 | 2019-03-19 |
| 1710446828 | David Redding Kingery Jr. | Student in an Organized Health Care Education/Training Program | Gme Office 809 82nd Parkway, Myrtle Beach, SC 29572 | 2019-03-18 |
| Find all providers in zip 29572 | ||||
| Taxonomy Code | 207YX0007X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Otolaryngology |
| Specialization | Plastic Surgery within the Head & Neck |
| An otolaryngologist with additional training in plastic and reconstructive procedures within the head, face, neck and associated structures, including cutaneous head and neck oncology and reconstruction, management of maxillofacial trauma, soft tissue repair and neural surgery. The field is diverse and involves a wide age range of patients, from the newborn to the aged. While both cosmetic and reconstructive surgeries are practiced, there are many additional procedures which interface with them. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definiton added, source added] Additional Resources: American Board of Otolaryngology, 2007. http://www.aboto.org/. Board certification for Medical Doctors (MDs) is provided by the American Board of Otolaryngology. Board certification for Doctors of Osteopathy is currently provided in the subspecialty of Otolaryngology/Facial Plastic Surgery (see Taxonomy Code 207YX0905X) |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1124087101 | Daniel L Rosner | Otolaryngology | 915 Medical Circle, Myrtle Beach, SC 29572 | 2006-03-20 |
| 1215996822 | Calhoun D Cunningham | Otolaryngology | 1021 Cipriana Dr, Ste 220, Myrtle Beach, SC 29572-4621 | 2006-03-22 |
| 1346209848 | Richard C Osman | Otolaryngology | 915 Medical Circle, Myrtle Beach, SC 29572 | 2006-03-22 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1902043185 | Ear Nose Throat and Audiology Associates | Otolaryngology | 327 W South St, Union, SC 29379-2838 | 2009-01-09 |
| 1104873017 | Terry L Fry | Otolaryngology | 401 Marina Dr, Georgetown, SC 29440-2410 | 2006-05-27 |
| 1689723538 | Ear, Nose & Throat Associates of Florence | Otolaryngology | 800 E Cheves St, Suite 480, Florence, SC 29506-2650 | 2007-01-09 |
| 1669457016 | Raymond Samuel Kaplan | Otolaryngology | 125 Doughty St, Suite 280, Charleston, SC 29403-5736 | 2005-12-08 |
| City | MYRTLE BEACH |
| Zip Code | 29572 |
Please comment or provide details below to improve the information on COASTAL CAROLINA OTOLARYNGOLOGY ASSOCIATES,PA.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.