Basic Information
| Provider Information | |||||||||
| NPI: | 1881631554 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | SPORTSMEDICINE ATLANTIC ORTHOPAEDICS PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1900 LAFAYETTE RD | ||||||||
| Address2: | STE A | ||||||||
| City: | PORTSMOUTH | ||||||||
| State: | NH | ||||||||
| PostalCode: | 038015679 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6034311121 | ||||||||
| FaxNumber: | 6034313347 | ||||||||
| Practice Location | |||||||||
| Address1: | 1900 LAFAYETTE RD | ||||||||
| Address2: | STE A | ||||||||
| City: | PORTSMOUTH | ||||||||
| State: | NH | ||||||||
| PostalCode: | 038015679 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6034311121 | ||||||||
| FaxNumber: | 6034313347 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/01/2006 | ||||||||
| LastUpdateDate: | 03/08/2016 | ||||||||
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| AuthorizedOfficialLastName: | NOERDLINGER | ||||||||
| AuthorizedOfficialFirstName: | MAYO | ||||||||
| AuthorizedOfficialMiddleName: | A | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 6034311121 | ||||||||
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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 | 174400000X | Y | 193400000X SINGLE SPECIALTY GROUP | Other Service Providers | Specialist |
No ID Information.