Healthcare Provider Details

I. General information

NPI: 1255501300
Provider Name (Legal Business Name): THORACIC & VASCULAR ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/05/2008
Last Update Date: 06/05/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 GRIFFIN ROAD UNIT 6
PORTSMOUTH NH
03801
US

IV. Provider business mailing address

267 ROUTE 108 UNIT A
SOMERSWORTH NH
03878
US

V. Phone/Fax

Practice location:
  • Phone: 603-842-6060
  • Fax:
Mailing address:
  • Phone: 603-842-6060
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License Number6905
License Number StateNH
# 2
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number6905
License Number StateNH

VIII. Authorized Official

Name: ROBERT C ORAM
Title or Position: SURGEON/MEMBER
Credential: MD
Phone: 603-842-6060