Provider Demographics
NPI:1659464188
Name:SEACOAST GENERAL SURGERY, PC
Entity Type:Organization
Organization Name:SEACOAST GENERAL SURGERY, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ELLEN
Authorized Official - Middle Name:M
Authorized Official - Last Name:WALLPE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:603-749-2266
Mailing Address - Street 1:750 CENTRAL AVE
Mailing Address - Street 2:STE N
Mailing Address - City:DOVER
Mailing Address - State:NH
Mailing Address - Zip Code:03820
Mailing Address - Country:US
Mailing Address - Phone:603-749-2266
Mailing Address - Fax:603-749-3019
Practice Address - Street 1:750 CENTRAL AVE
Practice Address - Street 2:STE N
Practice Address - City:DOVER
Practice Address - State:NH
Practice Address - Zip Code:03820
Practice Address - Country:US
Practice Address - Phone:603-749-2266
Practice Address - Fax:603-749-3019
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-02
Last Update Date:2008-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30212570Medicaid
NH30212570Medicaid