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General NPI Number Information
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NPI Number | 1952373995
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Entity Type | Organization
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Legal Business Name | NORTHERN MAINE ENT ASSOCIATES
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Dates
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Enumeration Date | 02/03/2006
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Last Update Date | 02/25/2016
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Provider Practice Location Address
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Address Line | 180 ACADEMY ST SUITE 1
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City | PRESQUE ISLE
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State | ME
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Zip | 04769-3145
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Country | US
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Telephone | 207-760-8100
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Fax | 207-760-8188
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Provider Business Mailing Address
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Address Line | 180 ACADEMY ST SUITE 1
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City | PRESQUE ISLE
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State | ME
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Zip | 04769-3145
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Country | US
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Telephone | 207-760-8100
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Fax | 207-760-8188
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Authorized Official
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Title or Position | OWNER/PRESIDENT
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Name | DR. NARAYANA MENTA PRASANNA
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Credential | MD
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Telephone | 207-760-8100
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Y00000X
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Taxonomy Name | Otolaryngology Physician
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License Number | 008959
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License Number State | ME
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