Organization
LAKES REGION UROLOGY, PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DANIEL JAMES PATRISSO M.D (OWNER)
(603) 524-8660
Entity
Organization
Contact information
Practice address
85 SPRING ST, LACONIA, NH 03246-3113
(603) 524-8660
(603) 528-6220
Mailing address
85 SPRING ST, LACONIA, NH 03246-3113
(603) 524-8660
(603) 528-6220
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
7001
NH
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
03021
NH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00000655
—
NH
01
—
1805036Y0NH01
ANTHEM ASC BILLING ID
NH
Enumeration date
01/12/2007
Last updated
11/08/2007
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