MEDICARE: NEW ENGLAND UROLOGY, P.A.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208800000X	Urology Physician

General Provider Information

NPI Number	:	1043297013
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NEW ENGLAND UROLOGY, P.A.

Provider Business Mailing Address
First Line	:	PO BOX 1849
Second Line	:
City	:	LEWISTON
State	:	ME
Zip	:	04241-1849
Country	:	US
Telephone Number	:	207-784-2554
Fax Number	:	207-777-5363

Provider Business Practice Location Address
First Line	:	20 HARTFORD ST
Second Line	:	SUITE 3
City	:	HOULTON
State	:	ME
Zip	:	04730-1891
Country	:	US
Telephone Number	:	207-532-0774
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	PRAKASH THAWAIT
Credential	:	M.D.
Telephone Number	:	207-532-0774

Provider Enumeration Date	:	12/29/2005
Last Update Date	:	08/22/2020

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