Provider Demographics
NPI:1245402460
Name:STEIN, BENJAMIN (MD,)
Entity Type:Individual
Prefix:DR
First Name:BENJAMIN
Middle Name:
Last Name:STEIN
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 1:77 BATES ST
Mailing Address - Street 2:STE. 202
Mailing Address - City:LEWISTON
Mailing Address - State:ME
Mailing Address - Zip Code:04240-7637
Mailing Address - Country:US
Mailing Address - Phone:207-784-5784
Mailing Address - Fax:207-784-1477
Practice Address - Street 1:77 BATES ST
Practice Address - Street 2:STE. 202
Practice Address - City:LEWISTON
Practice Address - State:ME
Practice Address - Zip Code:04240-7637
Practice Address - Country:US
Practice Address - Phone:207-784-5784
Practice Address - Fax:207-784-1477
Is Sole Proprietor?:No
Enumeration Date:2008-03-27
Last Update Date:2015-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEMD20464207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYJ400052428Medicare PIN