NPIMap

Organization Active NPI

Seaport Clinic LLC

Doing business as Seaport Medical Center

  • Internal Medicine Physician
  • Mystic, CT
National Provider Identifier
1881780773
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
Legal business name
SEAPORT CLINIC LLC
Doing business as
Seaport Medical Center
Practice address
56 Whitehall Ave
RT 27
Mystic, CT 06355
Phone
(860) 572-8282
Fax
(860) 572-7445
NPI assigned
Oct 5, 2006
Last updated
Aug 22, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Ms. Marie Altana Chiaradio
Title
Office Manager
Phone
(860) 572-8282

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X NU Primary

Addresses

Primary practice location

56 Whitehall Ave
RT 27
Mystic, CT 06355

Mailing address

56 Whitehall Ave
RT 27
Mystic, CT 06355
Phone (860) 572-8282

Other names 1

  • Seaport Medical Center Doing business as

National Provider Directory

National Provider Directory

Locations

56 Whitehall Ave
#27
Mystic, CT 06355
Phone (860) 572-8282

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/10489/brand/1/csg/1/fhir/r4

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1160006400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1881780773",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "56 WHITEHALL AVE",
            "address_2": "RT 27",
            "city": "MYSTIC",
            "state": "CT",
            "postal_code": "06355",
            "telephone_number": "860-572-8282",
            "fax_number": "860-572-7445"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "56 WHITEHALL AVE",
            "address_2": "RT 27",
            "city": "MYSTIC",
            "state": "CT",
            "postal_code": "06355",
            "telephone_number": "860-572-8282",
            "fax_number": "860-572-7445"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SEAPORT CLINIC LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-05",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "CHIARADIO",
        "authorized_official_first_name": "MARIE",
        "authorized_official_middle_name": "ALTANA",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "860-572-8282",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Seaport Medical Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Mystic, CT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.