Provider Demographics
NPI:1346003498
Name:BENSON, GABRIEL MICHAEL (ATS, RMA, RPT)
Entity Type:Individual
Prefix:
First Name:GABRIEL
Middle Name:MICHAEL
Last Name:BENSON
Suffix:
Gender:M
Credentials:ATS, RMA, RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 HUDSON ST APT 2714
Mailing Address - Street 2:
Mailing Address - City:ORONO
Mailing Address - State:ME
Mailing Address - Zip Code:04473-4523
Mailing Address - Country:US
Mailing Address - Phone:207-731-1223
Mailing Address - Fax:
Practice Address - Street 1:168 COLLEGE AVE
Practice Address - Street 2:
Practice Address - City:ORONO
Practice Address - State:ME
Practice Address - Zip Code:04473-1513
Practice Address - Country:US
Practice Address - Phone:207-581-1865
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-01
Last Update Date:2024-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MENA390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program