Healthcare Provider Details

I. General information

NPI: 1598865404
Provider Name (Legal Business Name): MEREDITH A BENNET MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/22/2006
Last Update Date: 09/04/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

335 BRIGHTON AVE
PORTLAND ME
04102-2362
US

IV. Provider business mailing address

22 BRAMHALL ST
PORTLAND ME
04102-3134
US

V. Phone/Fax

Practice location:
  • Phone: 207-662-8111
  • Fax:
Mailing address:
  • Phone: 207-662-7010
  • Fax: 207-662-7025

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number007711
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: