Provider Demographics
NPI:1376991505
Name:SPORTS MEDICINE NORTH ORTHOPAEDIC SURGERY, INC
Entity Type:Organization
Organization Name:SPORTS MEDICINE NORTH ORTHOPAEDIC SURGERY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:J
Authorized Official - Last Name:FEHNEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:978-818-6350
Mailing Address - Street 1:1 ORTHOPEDICS DR
Mailing Address - Street 2:
Mailing Address - City:PEABODY
Mailing Address - State:MA
Mailing Address - Zip Code:01960-1668
Mailing Address - Country:US
Mailing Address - Phone:978-818-6428
Mailing Address - Fax:
Practice Address - Street 1:20 HENRY GRAF JR ROAD
Practice Address - Street 2:
Practice Address - City:NEWBURYPORT
Practice Address - State:MA
Practice Address - Zip Code:01950-4008
Practice Address - Country:US
Practice Address - Phone:978-818-6350
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-27
Last Update Date:2021-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedicGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAM15814Medicare PIN