Provider Demographics
NPI:1730376799
Name:COASTAL NEUROLOGY, INC
Entity type:Organization
Organization Name:COASTAL NEUROLOGY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CARLO
Authorized Official - Middle Name:G
Authorized Official - Last Name:BROGNA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:401-596-6207
Mailing Address - Street 1:101 AIRPORT RD
Mailing Address - Street 2:
Mailing Address - City:WESTERLY
Mailing Address - State:RI
Mailing Address - Zip Code:02891-3430
Mailing Address - Country:US
Mailing Address - Phone:401-596-6207
Mailing Address - Fax:401-596-6238
Practice Address - Street 1:101 AIRPORT RD
Practice Address - Street 2:
Practice Address - City:WESTERLY
Practice Address - State:RI
Practice Address - Zip Code:02891-3430
Practice Address - Country:US
Practice Address - Phone:401-596-6207
Practice Address - Fax:401-596-6238
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-03
Last Update Date:2007-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIRI70072084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
RIC90273Medicare UPIN