Basic Information
| Provider Information | |||||||||
| NPI: | 1003039926 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SEACOAST MEDICAL ASSOCIATES, PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 21 HIGHLAND AVE | ||||||||
| Address2: | SUITE 24 | ||||||||
| City: | NEWBURYPORT | ||||||||
| State: | MA | ||||||||
| PostalCode: | 019503872 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9784621555 | ||||||||
| FaxNumber: | 9784621560 | ||||||||
| Practice Location | |||||||||
| Address1: | 21 HIGHLAND AVE | ||||||||
| Address2: | SUITE 24 | ||||||||
| City: | NEWBURYPORT | ||||||||
| State: | MA | ||||||||
| PostalCode: | 019503872 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9784621555 | ||||||||
| FaxNumber: | 9784621560 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/10/2007 | ||||||||
| LastUpdateDate: | 12/31/2014 | ||||||||
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| AuthorizedOfficialLastName: | MACDONALD | ||||||||
| AuthorizedOfficialFirstName: | ROBIN | ||||||||
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| AuthorizedOfficialTitleorPosition: | OFFICE MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 9784621555 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 153766 | MA | Y | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | M15982 | 01 | PTAN | OTHER | A30492 | 01 | IND MEDICARE PROVIDER NUM | OTHER | 9773649 | 05 | MA | MEDICAID |