| Coastal Gastroenterology Associates, Pa | |
|
1015 Medical Center Blvd Suite 1300 Webster TX 77598-4052 | |
| (281) 557-2527 | |
| (281) 557-7203 |
| Full Name | Coastal Gastroenterology Associates, Pa |
|---|---|
| Speciality | Internal Medicine |
| Location | 1015 Medical Center Blvd, Webster, Texas |
| Authorized Official Name and Position | Kalyanam Subramanyam (PRESIDENT) |
| Authorized Official Contact | 2815572527 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Coastal Gastroenterology Associates, Pa 1015 Medical Center Blvd Suite 1300 Webster TX 77598-4052 Ph: (281) 557-2527 | Coastal Gastroenterology Associates, Pa 1015 Medical Center Blvd Suite 1300 Webster TX 77598-4052 Ph: (281) 557-2527 |
| NPI Number | 1043312515 |
|---|---|
| Provider Enumeration Date | 09/03/2006 |
| Last Update Date | 06/02/2014 |
| Medicare PECOS PAC ID | 4789686809 |
|---|---|
| Medicare Enrollment ID | O20070220000668 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1043312515 | NPI | - | NPPES |
| 2226780 | Other | TX | BCBS - TX - BLUE LINK ID |
| 5283 | Other | RR MCR GROUP NUMBER | |
| 4102895 | Other | AETNA | |
| P00440059 | Other | RR MCR | |
| 1164493870 | Other | NPI - INDIVIDUAL | |
| B26780 | Other | MCR UPIN - INDIVIDUAL | |
| 114758902 | Other | TX | THMP - DR. SUBRAMANYAM |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207RG0100X | Internal Medicine - Gastroenterology | (* (Not Available)) | Primary |
| Provider Name | Kalyanam Subramanyam |
|---|---|
| Provider Type | Practitioner - Gastroenterology |
| Provider Identifiers | NPI Number: 1164493870 PECOS PAC ID: 3779685888 Enrollment ID: I20070420000483 |
| Provider Name | Advitya Malhotra |
|---|---|
| Provider Type | Practitioner - Gastroenterology |
| Provider Identifiers | NPI Number: 1609070275 PECOS PAC ID: 1052444718 Enrollment ID: I20100802000199 |
| Provider Name | Diana Pham |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1346627312 PECOS PAC ID: 1850600552 Enrollment ID: I20151020002037 |
| Provider Name | Jesseca L Izquierdo |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1962159616 PECOS PAC ID: 4486022910 Enrollment ID: I20221115000506 |
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