Provider Demographics
NPI:1003039926
Name:SEACOAST MEDICAL ASSOCIATES, PC
Entity Type:Organization
Organization Name:SEACOAST MEDICAL ASSOCIATES, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ROBIN
Authorized Official - Middle Name:
Authorized Official - Last Name:MACDONALD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:978-462-1555
Mailing Address - Street 1:21 HIGHLAND AVE
Mailing Address - Street 2:SUITE 24
Mailing Address - City:NEWBURYPORT
Mailing Address - State:MA
Mailing Address - Zip Code:01950-3872
Mailing Address - Country:US
Mailing Address - Phone:978-462-1555
Mailing Address - Fax:978-462-1560
Practice Address - Street 1:21 HIGHLAND AVE
Practice Address - Street 2:SUITE 24
Practice Address - City:NEWBURYPORT
Practice Address - State:MA
Practice Address - Zip Code:01950-3872
Practice Address - Country:US
Practice Address - Phone:978-462-1555
Practice Address - Fax:978-462-1560
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-10
Last Update Date:2014-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA153766207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
M15982OtherPTAN
A30492OtherIND MEDICARE PROVIDER NUM
MA9773649Medicaid
M15982OtherPTAN