# SEACOAST ORTHOPEDIC SURGERY & SPORTS MEDICINE LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1114979614
- **Authorized official:** STEVEN B CARLOW MD (DOCTOR)
- **Authorized official phone:** (860) 449-1413

## Contact information

- **Practice address:** 495 ROUTE 184, SUITE 300, GROTON, CT 06340
- **Practice address phone:** (860) 449-1413
- **Practice address fax:** (860) 449-0390
- **Mailing address:** 495 ROUTE 184, SUITE 300, GROTON, CT 06340
- **Mailing address phone:** (860) 449-1413
- **Mailing address fax:** (860) 449-0390

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207X00000X | Orthopaedic Surgery Physician | — | NULL | Yes |
| 207X00000X | Orthopaedic Surgery Physician | — | — | Yes |

## Other

- **Enumeration date:** 05/16/2006
- **Last updated:** 01/23/2013

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 001253582 | — | CT |
| 05 | — | 001272939 | — | CT |
| 05 | — | 001409756 | — | CT |
| 05 | — | 004237146 | — | CT |
| 01 | — | 040975 | LICENSE NUMBER | CT |
| 01 | — | 047870 | LICENSE NUMBER | CT |