Healthcare Provider Details

I. General information

NPI: 1184608101
Provider Name (Legal Business Name): ATLANTIC CARDIOLOGY ASSOC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/02/2005
Last Update Date: 05/24/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

333 BORTHWICK AVE SUITE 401
PORTSMOUTH NH
03801-7128
US

IV. Provider business mailing address

333 BORTHWICK AVE SUITE 401
PORTSMOUTH NH
03801-7128
US

V. Phone/Fax

Practice location:
  • Phone: 603-433-5300
  • Fax: 603-433-0838
Mailing address:
  • Phone: 603-433-5300
  • Fax: 603-433-0838

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number437R
License Number StateNH
# 2
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number State

VIII. Authorized Official

Name: MARK I JACOBS
Title or Position: MANAGING PARTNER
Credential: MD
Phone: 603-443-5300