Provider Demographics
NPI:1952373995
Name:NORTHERN MAINE ENT ASSOCIATES
Entity Type:Organization
Organization Name:NORTHERN MAINE ENT ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:NARAYANA
Authorized Official - Middle Name:MENTA
Authorized Official - Last Name:PRASANNA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:207-760-8100
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-03
Last Update Date:2016-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME008959207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME000418OtherANTHEM BLUESHIELD STAR ID
MECH6750OtherRAILROAD MEDICARE PROV ID
ME109080000Medicaid
ME287280099Medicaid
ME000418OtherANTHEM BLUESHIELD STAR ID