Healthcare Provider Details

I. General information

NPI: 1659464188
Provider Name (Legal Business Name): SEACOAST GENERAL SURGERY, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/02/2006
Last Update Date: 05/28/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

750 CENTRAL AVE STE N
DOVER NH
03820
US

IV. Provider business mailing address

750 CENTRAL AVE STE N
DOVER NH
03820
US

V. Phone/Fax

Practice location:
  • Phone: 603-749-2266
  • Fax: 603-749-3019
Mailing address:
  • Phone: 603-749-2266
  • Fax: 603-749-3019

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name: ELLEN M WALLPE
Title or Position: PRACTICE MANAGER
Credential:
Phone: 603-749-2266