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General NPI Number Information
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NPI Number | 1326198102
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Entity Type | Organization
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Legal Business Name | LAKES REGION UROLOGY, PA
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Dates
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Enumeration Date | 01/12/2007
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Last Update Date | 11/08/2007
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Provider Practice Location Address
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Address Line | 85 SPRING ST
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City | LACONIA
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State | NH
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Zip | 03246-3113
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Country | US
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Telephone | 603-524-8660
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Fax | 603-528-6220
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Provider Business Mailing Address
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Address Line | 85 SPRING ST
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City | LACONIA
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State | NH
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Zip | 03246-3113
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Country | US
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Telephone | 603-524-8660
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Fax | 603-528-6220
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Authorized Official
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Title or Position | OWNER
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Name | DR. DANIEL JAMES PATRISSO
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Credential | M.D
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Telephone | 603-524-8660
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 7001
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License Number State | NH
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Taxonomy #2
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Taxonomy Code | 261QA1903X
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Taxonomy Name | Ambulatory Surgical Clinic/Center
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License Number | 03021
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License Number State | NH
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