Organization
FORE RIVER UROLOGY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MEGAN SHOREY (OFFICE MANAGER)
(207) 776-2411
Entity
Organization
Contact information
Practice address
21 DONALD B DEAN DR, SUITE 1, SOUTH PORTLAND, ME 04106-3252
(207) 776-2411
Mailing address
21 DONALD B DEAN DR, SUITE 1, SOUTH PORTLAND, ME 04106-3252
(207) 776-2411
Taxonomy
Speciality
Code
Description
License number
State
208800000X
Urology Physician
Primary
—
—
2088F0040X
Urogynecology and Reconstructive Pelvic Surgery (Urology) Physician
—
—
2088P0231X
Pediatric Urology Physician
—
—
Other
Enumeration date
08/08/2013
Last updated
07/16/2024
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