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Organization

CHAMPION UROLOGY LTD

Active
Organization subpart
No

Provider details

NPI number
Authorized official
MRS. CONSTANCE LIN LUTZEL (OFFICE MANAGER)
(401) 596-0964
Entity
Organization

Contact information

Practice address
35 WELLS STREET, WESTERLY, RI 02891
(401) 596-0964
(401) 596-8634
Mailing address
35 WELLS ST, WESTERLY, RI 02891-2922
(401) 596-0964
(401) 596-8634

Taxonomy

Speciality
Code
Description
License number
State
208800000X
Urology Physician
040289
CT
208800000X
Urology Physician
10831
RI
208800000X
Urology Physician
Primary
7511
RI

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
003114204
CT
05
CU43922
RI
Enumeration date
08/04/2006
Last updated
04/25/2008
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