Provider Demographics
NPI:1477876670
Name:BENDER, EDWARD ISAAC (DO)
Entity Type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:ISAAC
Last Name:BENDER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1577 CONGRESS ST STE 1
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04102-2169
Mailing Address - Country:US
Mailing Address - Phone:207-662-1442
Mailing Address - Fax:207-775-2467
Practice Address - Street 1:1577 CONGRESS ST STE 1
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04102-2169
Practice Address - Country:US
Practice Address - Phone:207-662-1442
Practice Address - Fax:207-775-2467
Is Sole Proprietor?:No
Enumeration Date:2010-03-03
Last Update Date:2020-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEDO31102084P0804X, 2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry