Provider Demographics
NPI:1366462616
Name:SEACOAST ORTHOPEDIC ASSOC INC
Entity Type:Organization
Organization Name:SEACOAST ORTHOPEDIC ASSOC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:GORDON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:978-462-7555
Mailing Address - Street 1:21 HIGHLAND AVE
Mailing Address - Street 2:SUITE 16
Mailing Address - City:NEWBURYPORT
Mailing Address - State:MA
Mailing Address - Zip Code:01950-3872
Mailing Address - Country:US
Mailing Address - Phone:978-462-7555
Mailing Address - Fax:978-462-9049
Practice Address - Street 1:21 HIGHLAND AVE
Practice Address - Street 2:SUITE 16
Practice Address - City:NEWBURYPORT
Practice Address - State:MA
Practice Address - Zip Code:01950-3872
Practice Address - Country:US
Practice Address - Phone:978-462-7555
Practice Address - Fax:978-462-9049
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-20
Last Update Date:2012-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA97099329Medicaid
MA97099329Medicaid
MAM12169Medicare UPIN