=====================================================
General NPI Number Information
=====================================================
NPI Number | 1902088024
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | LAKES REGION UROLOGY PA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/30/2007
-----------------------------------------------------
Last Update Date | 11/30/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 85 SPRING ST
-----------------------------------------------------
City | LACONIA
-----------------------------------------------------
State | NH
-----------------------------------------------------
Zip | 03246-3113
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 603-524-8660
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 85 SPRING ST
-----------------------------------------------------
City | LACONIA
-----------------------------------------------------
State | NH
-----------------------------------------------------
Zip | 03246-3113
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OFFICE COORDINATOR
-----------------------------------------------------
Name | MRS. PATRICIA DUMONT
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 603-524-8660
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208800000X
-----------------------------------------------------
Taxonomy Name | Urology Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | NH
-----------------------------------------------------