=====================================================
General NPI Number Information
=====================================================
NPI Number | 1558469791
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | JOSEPH L BENOIT M D P A
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/20/2006
-----------------------------------------------------
Last Update Date | 12/20/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 700 MOUNT HOPE AVE SUITE 480
-----------------------------------------------------
City | BANGOR
-----------------------------------------------------
State | ME
-----------------------------------------------------
Zip | 04401-5691
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 207-990-1615
-----------------------------------------------------
Fax | 207-990-5997
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 700 MOUNT HOPE AVE SUITE 480
-----------------------------------------------------
City | BANGOR
-----------------------------------------------------
State | ME
-----------------------------------------------------
Zip | 04401-5691
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 207-990-1615
-----------------------------------------------------
Fax | 207-990-5997
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. JOSEPH LAWRENCE BENOIT
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 207-990-1615
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207V00000X
-----------------------------------------------------
Taxonomy Name | Obstetrics & Gynecology Physician
-----------------------------------------------------
License Number | 011974
-----------------------------------------------------
License Number State | ME
-----------------------------------------------------