Provider Demographics
NPI:1043409006
Name:COASTAL NEW HAMPSHIE NEUROSURGEONS
Entity Type:Organization
Organization Name:COASTAL NEW HAMPSHIE NEUROSURGEONS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SUZETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:PROFIO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:603-433-4666
Mailing Address - Street 1:330 BORTHWICK AVE
Mailing Address - Street 2:SUITE 108
Mailing Address - City:PORTSMOUTH
Mailing Address - State:NH
Mailing Address - Zip Code:03801-4174
Mailing Address - Country:US
Mailing Address - Phone:603-433-4666
Mailing Address - Fax:603-433-1338
Practice Address - Street 1:44 BIRCH ST
Practice Address - Street 2:SUITE 207
Practice Address - City:DERRY
Practice Address - State:NH
Practice Address - Zip Code:03038-2752
Practice Address - Country:US
Practice Address - Phone:603-433-4666
Practice Address - Fax:603-433-1338
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-16
Last Update Date:2007-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH80009465Medicaid
NHB86517Medicare UPIN
NHB64429Medicare UPIN
NH80009465Medicaid
NHNH9465Medicare PIN