Provider Demographics
NPI:1306245634
Name:SEACOAST ORTHOPEDICS AND SPORTS MEDICINE LLC
Entity type:Organization
Organization Name:SEACOAST ORTHOPEDICS AND SPORTS MEDICINE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:J
Authorized Official - Last Name:GLAZIER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:978-462-7555
Mailing Address - Street 1:21 HIGHLAND AVE
Mailing Address - Street 2:SUITE 16
Mailing Address - City:NEWBURYPORT
Mailing Address - State:MA
Mailing Address - Zip Code:01950-3872
Mailing Address - Country:US
Mailing Address - Phone:978-462-7555
Mailing Address - Fax:
Practice Address - Street 1:21 HIGHLAND AVE
Practice Address - Street 2:SUITE 16
Practice Address - City:NEWBURYPORT
Practice Address - State:MA
Practice Address - Zip Code:01950-3872
Practice Address - Country:US
Practice Address - Phone:978-462-7555
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SEACOAST ORTHOPEDIC ASSOC INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-08-22
Last Update Date:2014-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty