Basic Information
| Provider Information | |||||||||
| NPI: | 1255501300 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | THORACIC & VASCULAR ASSOCIATES | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | SEACOAST VEIN CENTER | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 267 ROUTE 108 | ||||||||
| Address2: | UNIT A | ||||||||
| City: | SOMERSWORTH | ||||||||
| State: | NH | ||||||||
| PostalCode: | 03878 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6038426060 | ||||||||
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| Practice Location | |||||||||
| Address1: | 200 GRIFFIN ROAD | ||||||||
| Address2: | UNIT 6 | ||||||||
| City: | PORTSMOUTH | ||||||||
| State: | NH | ||||||||
| PostalCode: | 03801 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6038426060 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/05/2008 | ||||||||
| LastUpdateDate: | 06/05/2008 | ||||||||
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| AuthorizedOfficialLastName: | ORAM | ||||||||
| AuthorizedOfficialFirstName: | ROBERT | ||||||||
| AuthorizedOfficialMiddleName: | C | ||||||||
| AuthorizedOfficialTitleorPosition: | SURGEON/MEMBER | ||||||||
| AuthorizedOfficialTelephone: | 6038426060 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208G00000X | 6905 | NH | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Thoracic Surgery (Cardiothoracic Vascular Surgery) | 2086S0129X | 6905 | NH | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Surgery | Vascular Surgery |
ID Information
| ID | Type | State | Issuer | Description | 140860000 | 05 | ME | MEDICAID | 80000986 | 05 | NH | MEDICAID | B4348 | 01 | RAILROAD MEDICARE | OTHER |