| Coastal Pediatric Associates, P.a. | |
|
2067 Charlie Hall Blvd Charleston SC 29414-5834 | |
| (843) 573-2535 | |
| (843) 573-2534 |
| Full Name | Coastal Pediatric Associates, P.a. |
|---|---|
| Speciality | Pediatrics |
| Location | 2067 Charlie Hall Blvd, Charleston, South Carolina |
| Authorized Official Name and Position | Robert Andrew Clifford (PARTNER) |
| Authorized Official Contact | 8435732535 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Coastal Pediatric Associates, P.a. 4975 Lacross Rd Ste 150 North Charleston SC 29406-6531 Ph: () - | Coastal Pediatric Associates, P.a. 2067 Charlie Hall Blvd Charleston SC 29414-5834 Ph: (843) 573-2535 |
| NPI Number | 1770700759 |
|---|---|
| Provider Enumeration Date | 04/19/2007 |
| Last Update Date | 08/02/2022 |
| Certification Date | 08/02/2022 |
| Medicare PECOS PAC ID | 8426464736 |
|---|---|
| Medicare Enrollment ID | O20210311001646 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1770700759 | NPI | - | NPPES |
| GP7882 | Medicaid | SC | |
| GP8228 | Medicaid | SC | |
| GP4680 | Medicaid | SC | |
| GP8203 | Medicaid | SC | |
| GP8237 | Medicaid | SC | |
| GP4716 | Medicaid | SC | |
| GP8229 | Medicaid | SC | |
| PG1066 | Medicaid | SC |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TH0100X | Psychologist - Health Service | (* (Not Available)) | Secondary |
| 208000000X | Pediatrics | (* (Not Available)) | Primary |
| Provider Name | Elizabeth J Kirlis |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1437126349 PECOS PAC ID: 3072559947 Enrollment ID: I20050630000413 |
| Provider Name | Kara Blevens Huncik |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1174598221 PECOS PAC ID: 3678500055 Enrollment ID: I20050719000154 |
| Provider Name | Kimberly Caristi |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1942275060 PECOS PAC ID: 6406880517 Enrollment ID: I20050919000707 |
| Provider Name | William Graham |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1316913072 PECOS PAC ID: 9234163288 Enrollment ID: I20050920000767 |
| Provider Name | Robert A Clifford |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1780659284 PECOS PAC ID: 5193759066 Enrollment ID: I20050920001095 |
| Provider Name | Ana I Arias-pandey |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1740443464 PECOS PAC ID: 3274706817 Enrollment ID: I20111027000278 |
| Provider Name | Stephen Stripling |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1538122205 PECOS PAC ID: 7315996055 Enrollment ID: I20210326000745 |
| Provider Name | Meghan Ondo Geils |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1457306292 PECOS PAC ID: 0941609812 Enrollment ID: I20210526000026 |
| Provider Name | Mohammed M Al Gadban |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1043697022 PECOS PAC ID: 7214246826 Enrollment ID: I20210526000364 |
| Provider Name | Kelly C Havig-lipke |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1780639674 PECOS PAC ID: 9537568456 Enrollment ID: I20210526002020 |
| Provider Name | Tricia Dudek Humphrey |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1073812731 PECOS PAC ID: 6709285646 Enrollment ID: I20210526002657 |
| Provider Name | Elizabeth Milliron |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1760630362 PECOS PAC ID: 3870762941 Enrollment ID: I20210528000759 |
| Provider Name | Kelli Elizabeth Johnston |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1689797268 PECOS PAC ID: 1052713492 Enrollment ID: I20210708000646 |
| Provider Name | Lauren M Lucas |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1912389628 PECOS PAC ID: 6608186440 Enrollment ID: I20210708001065 |
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