Provider Demographics
NPI:1508932922
Name:ATLANTIC SURGICAL PLLC
Entity Type:Organization
Organization Name:ATLANTIC SURGICAL PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:N
Authorized Official - Last Name:PACIULLI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:603-431-5242
Mailing Address - Street 1:PO BOX 2200
Mailing Address - Street 2:
Mailing Address - City:AMHERST
Mailing Address - State:NH
Mailing Address - Zip Code:03031-4200
Mailing Address - Country:US
Mailing Address - Phone:603-673-9411
Mailing Address - Fax:603-673-9899
Practice Address - Street 1:330 BORTHWICK AVE
Practice Address - Street 2:
Practice Address - City:PORTSMOUTH
Practice Address - State:NH
Practice Address - Zip Code:03801-4174
Practice Address - Country:US
Practice Address - Phone:603-431-5242
Practice Address - Fax:603-431-5091
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-28
Last Update Date:2007-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NHDF6919OtherRAILROAD MEDICARE
NH41639OtherCIGNA
NHDF6919OtherRAILROAD MEDICARE