| Intracoastal Internal Medicine | |
|
2580 Pickard Rd Wilmington NC 28403-4461 | |
| (910) 332-0701 | |
| (910) 332-0710 |
| Full Name | Intracoastal Internal Medicine |
|---|---|
| Speciality | Internal Medicine |
| Location | 2580 Pickard Rd, Wilmington, North Carolina |
| Authorized Official Name and Position | Kimberly Dahlstrom (ADMIN ASST) |
| Authorized Official Contact | 9103320701 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Intracoastal Internal Medicine 2580 Pickard Rd Wilmington NC 28403-4461 Ph: (910) 332-0701 | Intracoastal Internal Medicine 2580 Pickard Rd Wilmington NC 28403-4461 Ph: (910) 332-0701 |
| NPI Number | 1770515272 |
|---|---|
| Provider Enumeration Date | 07/07/2006 |
| Last Update Date | 06/19/2019 |
| Medicare PECOS PAC ID | 2668477878 |
|---|---|
| Medicare Enrollment ID | O20060921000486 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1770515272 | NPI | - | NPPES |
| 5903216 | Medicaid | NC | |
| 7005481 | Medicaid | NC | |
| 7005555 | Medicaid | NC | |
| 1467917880 | Medicaid | NC | |
| 1447204631 | Medicaid | NC | |
| 891069V | Medicaid | NC | |
| 8911484 | Medicaid | NC |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | (* (Not Available)) | Primary |
| Provider Name | Christopher C Cosgrove |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1790717296 PECOS PAC ID: 7113989427 Enrollment ID: I20060929000480 |
| Provider Name | Andre J Leonard |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1720019193 PECOS PAC ID: 9830194042 Enrollment ID: I20060929000487 |
| Provider Name | Michelle W Richardson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1194918052 PECOS PAC ID: 7214023613 Enrollment ID: I20071017000150 |
| Provider Name | Julie Crutchfield Nesbit |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1922156298 PECOS PAC ID: 4183786965 Enrollment ID: I20090105000285 |
| Provider Name | Erin C Dills |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1437343357 PECOS PAC ID: 6608909593 Enrollment ID: I20100728001263 |
| Provider Name | Ashley Rose Horne |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1467917880 PECOS PAC ID: 1557600434 Enrollment ID: I20190312001282 |
| Provider Name | Jenny Lee Trest Perkins |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1295358547 PECOS PAC ID: 2365840311 Enrollment ID: I20211006001542 |
| Provider Name | Lorraine Ellen Kelly |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1629736376 PECOS PAC ID: 4688069586 Enrollment ID: I20220310002788 |
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