Healthcare Provider Details

I. General information

NPI: 1346205457
Provider Name (Legal Business Name): MAINE UROLOGY ASSOCIATES P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/20/2006
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

336 MOUNT HOPE AVE SUITE 1
BANGOR ME
04401-4236
US

IV. Provider business mailing address

336 MOUNT HOPE AVE SUITE 1
BANGOR ME
04401-4236
US

V. Phone/Fax

Practice location:
  • Phone: 207-947-0469
  • Fax: 207-941-1957
Mailing address:
  • Phone: 207-947-0469
  • Fax: 207-941-1957

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number
License Number State

VIII. Authorized Official

Name: RICHARD JAMES LONG
Title or Position: PRESIDENT
Credential: M.D.
Phone: 207-947-0469