Provider Demographics
NPI:1386677169
Name:NORTHERN RADIOLOGICAL ASSOCIATES
Entity Type:Organization
Organization Name:NORTHERN RADIOLOGICAL ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LAURENCE
Authorized Official - Middle Name:A
Authorized Official - Last Name:WATTERSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:207-762-4641
Mailing Address - Street 1:49 2ND ST
Mailing Address - Street 2:
Mailing Address - City:PRESQUE ISLE
Mailing Address - State:ME
Mailing Address - Zip Code:04769-2637
Mailing Address - Country:US
Mailing Address - Phone:207-762-4641
Mailing Address - Fax:207-762-3336
Practice Address - Street 1:49 2ND ST
Practice Address - Street 2:
Practice Address - City:PRESQUE ISLE
Practice Address - State:ME
Practice Address - Zip Code:04769-2637
Practice Address - Country:US
Practice Address - Phone:207-762-4641
Practice Address - Fax:207-762-3336
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MEN1000OtherANTHEM BC/BS
152724Medicare ID - Type Unspecified
152719Medicare ID - Type Unspecified