Healthcare Provider Details

I. General information

NPI: 1457047086
Provider Name (Legal Business Name): BENJAMIN DAVID PACKARD DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/17/2023
Last Update Date: 07/15/2026
Certification Date: 07/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 MAIN ST
LEWISTON ME
04240-7027
US

IV. Provider business mailing address

14 MAINE ST
BRUNSWICK ME
04011-2049
US

V. Phone/Fax

Practice location:
  • Phone: 207-795-0111
  • Fax: 207-755-5875
Mailing address:
  • Phone: 207-725-9065
  • Fax: 207-560-9904

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number074407
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: