Healthcare Provider Details

I. General information

NPI: 1346573391
Provider Name (Legal Business Name): SEACOAST ORTHOPEDICS & SPORTS MEDICINE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/09/2009
Last Update Date: 11/13/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

65 CALEF HWY SUITE 206
LEE NH
03861-6703
US

IV. Provider business mailing address

7 MARSH BROOK DR SUITE 205
SOMERSWORTH NH
03878-6523
US

V. Phone/Fax

Practice location:
  • Phone: 603-742-2007
  • Fax: 603-749-4605
Mailing address:
  • Phone: 603-742-2007
  • Fax: 603-749-4605

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207XS0106X
TaxonomyOrthopaedic Hand Surgery Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: PAUL J KAYNE
Title or Position: PRACTICE ADMINISTRATOR
Credential: CMPE
Phone: 603-742-2007