Basic Information
| Provider Information | |||||||||
| NPI: | 1689616328 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | THORACIC & VASCULAR ASSOCIATES | ||||||||
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| Mailing Information | |||||||||
| Address1: | 267 ROUTE 108 | ||||||||
| Address2: | UNIT A | ||||||||
| City: | SOMERSWORTH | ||||||||
| State: | NH | ||||||||
| PostalCode: | 03878 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6038426060 | ||||||||
| FaxNumber: | 6036926040 | ||||||||
| Practice Location | |||||||||
| Address1: | 267 ROUTE 108 | ||||||||
| Address2: | UNIT A | ||||||||
| City: | SOMERSWORTH | ||||||||
| State: | NH | ||||||||
| PostalCode: | 03878 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6038426060 | ||||||||
| FaxNumber: | 6036926040 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/10/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | ORAM | ||||||||
| AuthorizedOfficialFirstName: | ROBERT | ||||||||
| AuthorizedOfficialMiddleName: | C | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 6038426060 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208G00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Thoracic Surgery (Cardiothoracic Vascular Surgery) |
ID Information
| ID | Type | State | Issuer | Description | MM6738 | 01 | ME | MEDICARE | OTHER | 20000986 | 05 | NH | MEDICAID |