Provider Demographics
NPI:1881666816
Name:PRASANNA, NARAYANA MENTA (MD)
Entity Type:Individual
Prefix:DR
First Name:NARAYANA
Middle Name:MENTA
Last Name:PRASANNA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:180 ACADEMY ST
Mailing Address - Street 2:SUITE 1
Mailing Address - City:PRESQUE ISLE
Mailing Address - State:ME
Mailing Address - Zip Code:04769-3145
Mailing Address - Country:US
Mailing Address - Phone:207-760-8100
Mailing Address - Fax:207-760-8188
Practice Address - Street 1:180 ACADEMY ST
Practice Address - Street 2:SUITE 1
Practice Address - City:PRESQUE ISLE
Practice Address - State:ME
Practice Address - Zip Code:04769-3145
Practice Address - Country:US
Practice Address - Phone:207-760-8100
Practice Address - Fax:207-760-8188
Is Sole Proprietor?:No
Enumeration Date:2006-02-03
Last Update Date:2007-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME008959207Y00000X, 207YX0602X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
No207YX0602XAllopathic & Osteopathic PhysiciansOtolaryngologyOtolaryngic Allergy
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME109080000Medicaid
MECH6750OtherRAILROAD MEDICARE
ME000418OtherANTHEM STAR ID
ME287280099Medicaid
ME109080000Medicaid
ME045338Medicare PIN