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NPI Code Detail

MEDICARE: UROLOGIC ASSOCIATES OF WILKES BARRE INC

MEDICARE: UROLOGIC ASSOCIATES OF WILKES BARRE INC
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
1208800000XUrology Physician

General Provider Information

NPI Number : 1043412265
Entity Type Code : Organization
Provider Name (Legal Business Name) : UROLOGIC ASSOCIATES OF WILKES BARRE INC
Provider Business Mailing Address
First Line : 470 WYOMING AVE
Second Line :
City : KINGSTON
State : PA
Zip : 18704-3603
Country : US
Telephone Number : 570-288-4551
Fax Number : 570-287-7999
Provider Business Practice Location Address
First Line : 470 WYOMING AVE
Second Line :
City : KINGSTON
State : PA
Zip : 18704-3603
Country : US
Telephone Number : 570-288-4551
Fax Number : 570-287-7999
Authorized Official
Title or Position : OWNER
Name : HARAGOPAL PENUGONDA
Credential : MD
Telephone Number : 570-288-4551
Provider Enumeration Date : 06/01/2007
Last Update Date : 08/22/2020

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