Organization
NORTHERN MAINE ENT ASSOCIATES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. NARAYANA MENTA PRASANNA MD (OWNER/PRESIDENT)
(207) 760-8100
Entity
Organization
Contact information
Practice address
180 ACADEMY ST, SUITE 1, PRESQUE ISLE, ME 04769-3145
(207) 760-8100
(207) 760-8188
Mailing address
180 ACADEMY ST, SUITE 1, PRESQUE ISLE, ME 04769-3145
(207) 760-8100
(207) 760-8188
Taxonomy
Speciality
Code
Description
License number
State
207Y00000X
Otolaryngology Physician
Primary
008959
ME
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000418
ANTHEM BLUESHIELD STAR ID
ME
05
—
109080000
—
ME
05
—
287280099
—
ME
01
—
CH6750
RAILROAD MEDICARE PROV ID
ME
Enumeration date
02/03/2006
Last updated
02/25/2016
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