Provider Demographics
NPI:1437109287
Name:SEACOAST GASTROENTEROLOGY
Entity type:Organization
Organization Name:SEACOAST GASTROENTEROLOGY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:JUDITH
Authorized Official - Middle Name:EILEEN
Authorized Official - Last Name:MINAUDO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:603-772-0222
Mailing Address - Street 1:3 ALUMNI DR
Mailing Address - Street 2:SUITE 202
Mailing Address - City:EXETER
Mailing Address - State:NH
Mailing Address - Zip Code:03833-2119
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3 ALUMNI DR
Practice Address - Street 2:SUITE 202
Practice Address - City:EXETER
Practice Address - State:NH
Practice Address - Zip Code:03833-2119
Practice Address - Country:US
Practice Address - Phone:603-772-0222
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30008082Medicaid
NHRE3683Medicare ID - Type Unspecified