Provider Demographics
NPI:1225170624
Name:LANNON, BENJAMIN MICHAEL (MD)
Entity Type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:MICHAEL
Last Name:LANNON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:778 MAIN ST
Mailing Address - Street 2:SUITE 2
Mailing Address - City:SOUTH PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04106-5447
Mailing Address - Country:US
Mailing Address - Phone:207-358-7600
Mailing Address - Fax:207-761-7019
Practice Address - Street 1:778 MAIN ST
Practice Address - Street 2:SUITE 2
Practice Address - City:SOUTH PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04106-5447
Practice Address - Country:US
Practice Address - Phone:207-358-7600
Practice Address - Fax:207-761-7019
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-13
Last Update Date:2011-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA217837207V00000X
MA231397207VE0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VE0102XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyReproductive Endocrinology
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology