Provider Demographics
NPI:1184608101
Name:ATLANTIC CARDIOLOGY ASSOC
Entity type:Organization
Organization Name:ATLANTIC CARDIOLOGY ASSOC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:I
Authorized Official - Last Name:JACOBS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:603-443-5300
Mailing Address - Street 1:333 BORTHWICK AVE
Mailing Address - Street 2:SUITE 401
Mailing Address - City:PORTSMOUTH
Mailing Address - State:NH
Mailing Address - Zip Code:03801-7128
Mailing Address - Country:US
Mailing Address - Phone:603-433-5300
Mailing Address - Fax:603-433-0838
Practice Address - Street 1:333 BORTHWICK AVE
Practice Address - Street 2:SUITE 401
Practice Address - City:PORTSMOUTH
Practice Address - State:NH
Practice Address - Zip Code:03801-7128
Practice Address - Country:US
Practice Address - Phone:603-433-5300
Practice Address - Fax:603-433-0838
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-02
Last Update Date:2013-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH437R291U00000X
207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
No291U00000XLaboratoriesClinical Medical LaboratoryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
95Y002150NH01OtherANTHEM
NH30005060Medicaid
C10781OtherRAILROAD
5141OtherCIGNA
C10781OtherRAILROAD