Healthcare Provider Details

I. General information

NPI: 1952373995
Provider Name (Legal Business Name): NORTHERN MAINE ENT ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/03/2006
Last Update Date: 02/25/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

180 ACADEMY ST SUITE 1
PRESQUE ISLE ME
04769-3145
US

IV. Provider business mailing address

180 ACADEMY ST SUITE 1
PRESQUE ISLE ME
04769-3145
US

V. Phone/Fax

Practice location:
  • Phone: 207-760-8100
  • Fax: 207-760-8188
Mailing address:
  • Phone: 207-760-8100
  • Fax: 207-760-8188

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number008959
License Number StateME

VIII. Authorized Official

Name: DR. NARAYANA MENTA PRASANNA
Title or Position: OWNER/PRESIDENT
Credential: MD
Phone: 207-760-8100