Provider Demographics
NPI:1316048069
Name:ATLANTIC DIGESTIVE SPECIALISTS, PLLC
Entity type:Organization
Organization Name:ATLANTIC DIGESTIVE SPECIALISTS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:P
Authorized Official - Last Name:FLAVIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:603-692-2228
Mailing Address - Street 1:21 CLARK WAY
Mailing Address - Street 2:
Mailing Address - City:SOMERSWORTH
Mailing Address - State:NH
Mailing Address - Zip Code:03878
Mailing Address - Country:US
Mailing Address - Phone:603-692-2228
Mailing Address - Fax:
Practice Address - Street 1:21 CLARK WAY
Practice Address - Street 2:
Practice Address - City:SOMERSWORTH
Practice Address - State:NH
Practice Address - Zip Code:03878-4401
Practice Address - Country:US
Practice Address - Phone:603-692-2228
Practice Address - Fax:603-692-0418
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-26
Last Update Date:2017-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NHNH3885Medicare ID - Type Unspecified