Provider Demographics
NPI:1083636567
Name:NORTH SHORE UROLOGICAL ASSOC., INC
Entity type:Organization
Organization Name:NORTH SHORE UROLOGICAL ASSOC., INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:S
Authorized Official - Last Name:LEDBETTER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:978-927-0714
Mailing Address - Street 1:PARKHURST MEDICAL BUILDING, SUITE 219
Mailing Address - Street 2:75 HERRICK STREET
Mailing Address - City:BEVERLY
Mailing Address - State:MA
Mailing Address - Zip Code:01915
Mailing Address - Country:US
Mailing Address - Phone:978-927-0714
Mailing Address - Fax:978-927-9135
Practice Address - Street 1:75 HERRICK STREET
Practice Address - Street 2:PARKHURST MEDICAL BUILDING, SUITE 219
Practice Address - City:BEVERLY
Practice Address - State:MA
Practice Address - Zip Code:01915
Practice Address - Country:US
Practice Address - Phone:978-927-0714
Practice Address - Fax:978-927-9135
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-24
Last Update Date:2008-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty