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NPI Code Detail

MEDICARE: LAKE REGION UROLOGY

MEDICARE: LAKE REGION UROLOGY
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1302R00000XHealth Maintenance Organization195558NY

General Provider Information

NPI Number : 1306819230
Entity Type Code : Organization
Provider Name (Legal Business Name) : LAKE REGION UROLOGY
Provider Business Mailing Address
First Line : 192 GENESEE ST
Second Line :
City : AUBURN
State : NY
Zip : 13021-3361
Country : US
Telephone Number : 315-258-5253
Fax Number : 315-258-0202
Provider Business Practice Location Address
First Line : 192 GENESEE ST
Second Line :
City : AUBURN
State : NY
Zip : 13021-3361
Country : US
Telephone Number : 315-258-5253
Fax Number : 315-258-0202
Authorized Official
Title or Position : PRESIDENT
Name : DR. WILLIAM HASTINGS FORESMAN
Credential : M.D.
Telephone Number : 315-258-5253
Provider Enumeration Date : 02/10/2006
Last Update Date : 06/19/2008

Similar Medicare Providers

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1144379884 — GERALD ORTEGO PA-C
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Directions to “LAKE REGION UROLOGY ” Practice Location

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