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General NPI Number Information
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NPI Number | 1386957470
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Entity Type | Organization
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Legal Business Name | SPORTSMEDICINE ATLANTIC ORTHOPAEDICS
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Dates
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Enumeration Date | 07/19/2010
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Last Update Date | 07/19/2010
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Provider Practice Location Address
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Address Line | 16 HOSPITAL DR
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City | YORK
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State | ME
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Zip | 03909-1011
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Country | US
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Telephone | 207-363-3490
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Fax | 603-431-3347
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Provider Business Mailing Address
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Address Line | 150 US HIGHWAY 1 BYP
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City | PORTSMOUTH
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State | NH
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Zip | 03801-5332
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Country | US
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Telephone | 603-431-1121
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Fax | 603-431-3347
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Authorized Official
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Title or Position | PHYSICIAN/PARTNER
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Name | DR. MAYO ANDREW NOERDLINGER
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Credential | MD
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Telephone | 603-431-1121
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number | 015677
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License Number State | ME
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