Healthcare Provider Details

I. General information

NPI: 1558469791
Provider Name (Legal Business Name): JOSEPH L BENOIT M D P A
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 12/20/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 MOUNT HOPE AVE SUITE 480
BANGOR ME
04401-5691
US

IV. Provider business mailing address

700 MOUNT HOPE AVE SUITE 480
BANGOR ME
04401-5691
US

V. Phone/Fax

Practice location:
  • Phone: 207-990-1615
  • Fax: 207-990-5997
Mailing address:
  • Phone: 207-990-1615
  • Fax: 207-990-5997

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number011974
License Number StateME

VIII. Authorized Official

Name: DR. JOSEPH LAWRENCE BENOIT
Title or Position: OWNER
Credential: MD
Phone: 207-990-1615