Provider Demographics
NPI:1346205457
Name:MAINE UROLOGY ASSOCIATES P.A.
Entity Type:Organization
Organization Name:MAINE UROLOGY ASSOCIATES P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:LONG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:207-947-0469
Mailing Address - Street 1:336 MOUNT HOPE AVE
Mailing Address - Street 2:SUITE 1
Mailing Address - City:BANGOR
Mailing Address - State:ME
Mailing Address - Zip Code:04401-4236
Mailing Address - Country:US
Mailing Address - Phone:207-947-0469
Mailing Address - Fax:207-941-1957
Practice Address - Street 1:336 MOUNT HOPE AVE
Practice Address - Street 2:SUITE 1
Practice Address - City:BANGOR
Practice Address - State:ME
Practice Address - Zip Code:04401-4236
Practice Address - Country:US
Practice Address - Phone:207-947-0469
Practice Address - Fax:207-941-1957
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-20
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
152661Medicare ID - Type Unspecified