Basic Information
| Provider Information | |||||||||
| NPI: | 1538390604 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | SPORTSMEDICINE ATLANTIC ORTHOPAEDICS, P.A. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 150 US HIGHWAY 1 BYP | ||||||||
| Address2: | |||||||||
| City: | PORTSMOUTH | ||||||||
| State: | NH | ||||||||
| PostalCode: | 038015332 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6034311121 | ||||||||
| FaxNumber: | 6034312791 | ||||||||
| Practice Location | |||||||||
| Address1: | 150 US HIGHWAY 1 BYP | ||||||||
| Address2: | |||||||||
| City: | PORTSMOUTH | ||||||||
| State: | NH | ||||||||
| PostalCode: | 038015332 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6034311121 | ||||||||
| FaxNumber: | 6034312791 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/06/2009 | ||||||||
| LastUpdateDate: | 08/06/2009 | ||||||||
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| AuthorizedOfficialLastName: | NOERDLINGER | ||||||||
| AuthorizedOfficialFirstName: | MAYO | ||||||||
| AuthorizedOfficialMiddleName: | A. | ||||||||
| AuthorizedOfficialTitleorPosition: | PARTNER | ||||||||
| AuthorizedOfficialTelephone: | 6034311121 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 213E00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Podiatric Medicine & Surgery Service Providers | Podiatrist |
No ID Information.