Provider Demographics
NPI:1881631554
Name:SPORTSMEDICINE ATLANTIC ORTHOPAEDICS PA
Entity Type:Organization
Organization Name:SPORTSMEDICINE ATLANTIC ORTHOPAEDICS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MAYO
Authorized Official - Middle Name:A
Authorized Official - Last Name:NOERDLINGER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:603-431-1121
Mailing Address - Street 1:1900 LAFAYETTE RD
Mailing Address - Street 2:STE A
Mailing Address - City:PORTSMOUTH
Mailing Address - State:NH
Mailing Address - Zip Code:03801-5679
Mailing Address - Country:US
Mailing Address - Phone:603-431-1121
Mailing Address - Fax:603-431-3347
Practice Address - Street 1:1900 LAFAYETTE RD
Practice Address - Street 2:STE A
Practice Address - City:PORTSMOUTH
Practice Address - State:NH
Practice Address - Zip Code:03801-5679
Practice Address - Country:US
Practice Address - Phone:603-431-1121
Practice Address - Fax:603-431-3347
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-01
Last Update Date:2016-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NHRE4926Medicare PIN
MEMM7533Medicare PIN
ME1232140001Medicare NSC
NH1232140002Medicare NSC