Basic Information
| Provider Information | |||||||||
| NPI: | 1679552251 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LORENZO | ||||||||
| FirstName: | ROBERT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 30 CHASE AVE | ||||||||
| Address2: | |||||||||
| City: | WATERVILLE | ||||||||
| State: | ME | ||||||||
| PostalCode: | 049014624 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2078724400 | ||||||||
| FaxNumber: | 2078615299 | ||||||||
| Practice Location | |||||||||
| Address1: | 30 CHASE AVE | ||||||||
| Address2: | |||||||||
| City: | WATERVILLE | ||||||||
| State: | ME | ||||||||
| PostalCode: | 049014624 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2078724400 | ||||||||
| FaxNumber: | 2078615299 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/12/2006 | ||||||||
| LastUpdateDate: | 11/08/2013 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2081S0010X | 016370 | ME | Y | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation | Sports Medicine |
No ID Information.