=====================================================
General NPI Number Information
=====================================================
NPI Number | 1134143621
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SEACOAST CARDIOLOGY ASSOCIATES, P.A.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/27/2006
-----------------------------------------------------
Last Update Date | 03/04/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 750 CENTRAL AVE SUITE U
-----------------------------------------------------
City | DOVER
-----------------------------------------------------
State | NH
-----------------------------------------------------
Zip | 03820-3434
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 603-742-9373
-----------------------------------------------------
Fax | 603-742-4061
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 12 HOSPITAL DR SUITE 9
-----------------------------------------------------
City | YORK
-----------------------------------------------------
State | ME
-----------------------------------------------------
Zip | 03909-1030
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 207-363-6136
-----------------------------------------------------
Fax | 207-363-6136
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OFFICE MANAGER
-----------------------------------------------------
Name | PAULA WANDLAND
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 207-363-6136
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RC0000X
-----------------------------------------------------
Taxonomy Name | Cardiovascular Disease Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------