Provider Demographics
NPI:1518951201
Name:BENSON, DANIEL JAMES (DPM)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:JAMES
Last Name:BENSON
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:58 CROSS RD
Mailing Address - Street 2:
Mailing Address - City:SOUTH CHINA
Mailing Address - State:ME
Mailing Address - Zip Code:04358-4007
Mailing Address - Country:US
Mailing Address - Phone:207-626-0100
Mailing Address - Fax:207-626-0800
Practice Address - Street 1:12 SPRUCE ST
Practice Address - Street 2:SUITE #5
Practice Address - City:AUGUSTA
Practice Address - State:ME
Practice Address - Zip Code:04330-5204
Practice Address - Country:US
Practice Address - Phone:207-626-0100
Practice Address - Fax:207-626-0800
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-08
Last Update Date:2012-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPOD1012213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME040971OtherBLUE CROSS/BLUE SHIELD
ME010539997OtherTAX ID
ME134580000Medicaid
ME134580000Medicaid
ME040971OtherBLUE CROSS/BLUE SHIELD