1427020395 NPI number — SEACOAST RADIOLOGY, PA

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1427020395 NPI number — SEACOAST RADIOLOGY, PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SEACOAST RADIOLOGY, PA
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
DOVER-ROCHESTER ASSOCIATES IN RADIOLOGY, PA
Provider Other Organization Name Type Code:
4
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1427020395
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/10/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 9567
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MANCHESTER
Provider Business Mailing Address State Name:
NH
Provider Business Mailing Address Postal Code:
03108-9567
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
603-516-1307
Provider Business Mailing Address Fax Number:
603-516-1308

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
789 CENTRAL AVENUE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DOVER
Provider Business Practice Location Address State Name:
NH
Provider Business Practice Location Address Postal Code:
03820-6420
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
603-516-1307
Provider Business Practice Location Address Fax Number:
603-516-4221
Provider Enumeration Date:
02/06/2006

Additional Information

Authorized Official

Authorized Official Last Name:
CIASCHINI
Authorized Official First Name:
MICHAEL
Authorized Official Middle Name:
W
Authorized Official Title or Position:
AUTHORIZED OFFICIAL
Authorized Official Telephone Number:
603-516-1307

Provider Taxonomy Codes

  • Taxonomy code: 2085R0202X , registered in the state of NH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 82304030 , issued by the state of ( NH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 164 . This is a "CIGNA HEALTHCARE HMO" identifier , issued by the state of ( NH ) . This identifiers is of the category "OTHER".
  • Identifier: DOVE304030 . This is a "ANTHEM BC & BS NH" identifier , issued by the state of ( NH ) . This identifiers is of the category "OTHER".




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