Healthcare Provider Details

I. General information

NPI: 1497603393
Provider Name (Legal Business Name): BENJAMIN ROBERT CHASSE PA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: BENJAMIN CHASSE PA

II. Dates (important events)

Enumeration Date: 03/18/2026
Last Update Date: 07/23/2026
Certification Date: 07/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22 BRAMHALL ST
PORTLAND ME
04102-3134
US

IV. Provider business mailing address

22 BRAMHALL ST
PORTLAND ME
04102-3134
US

V. Phone/Fax

Practice location:
  • Phone: 207-885-9905
  • Fax: 207-396-5600
Mailing address:
  • Phone: 207-885-9905
  • Fax: 207-396-5600

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA3115
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: