MEDICARE: DR. KAREN M BENEZRA D.O.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	1900	ME
2	204D00000X	Neuromusculoskeletal Medicine & OMM Physician	1900	ME

General Provider Information

NPI Number	:	1003006271
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KAREN M BENEZRA D.O.

Provider Business Mailing Address
First Line	:	PO BOX 827
Second Line	:
City	:	KENNEBUNK
State	:	ME
Zip	:	04043-0827
Country	:	US
Telephone Number	:	207-608-6864
Fax Number	:	888-972-4103

Provider Business Practice Location Address
First Line	:	1232 PORTLAND RD
Second Line	:
City	:	ARUNDEL
State	:	ME
Zip	:	04046-8104
Country	:	US
Telephone Number	:	207-608-6864
Fax Number	:	207-502-7211

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/25/2007
Last Update Date	:	01/04/2022

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