Healthcare Provider Details

I. General information

NPI: 1679516181
Provider Name (Legal Business Name): ANDRE BENOIT JR. M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/13/2006
Last Update Date: 10/28/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

45 HERRICK RD
SOUTHWEST HARBOR ME
04679-4433
US

IV. Provider business mailing address

50 UNION ST
ELLSWORTH ME
04605-1534
US

V. Phone/Fax

Practice location:
  • Phone: 207-244-5513
  • Fax: 207-664-5515
Mailing address:
  • Phone: 207-664-5513
  • Fax: 207-664-5515

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number009835
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: