Provider Demographics
NPI:1821204579
Name:ASSOCIATED UROLOGISTS PC
Entity Type:Organization
Organization Name:ASSOCIATED UROLOGISTS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ARTHUR
Authorized Official - Middle Name:E
Authorized Official - Last Name:LAMONTAGNE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:860-643-2731
Mailing Address - Street 1:116 E CENTER ST
Mailing Address - Street 2:SUITE 19
Mailing Address - City:MANCHESTER
Mailing Address - State:CT
Mailing Address - Zip Code:06040-5215
Mailing Address - Country:US
Mailing Address - Phone:860-643-2731
Mailing Address - Fax:860-643-6760
Practice Address - Street 1:116 E CENTER ST
Practice Address - Street 2:SUITE 19
Practice Address - City:MANCHESTER
Practice Address - State:CT
Practice Address - Zip Code:06040-5215
Practice Address - Country:US
Practice Address - Phone:860-643-2731
Practice Address - Fax:860-643-6760
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT17156208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT4001350Medicaid
CTC00145Medicare ID - Type Unspecified