Provider Demographics
NPI:1558367995
Name:BENSON, JEAN S (MD)
Entity Type:Individual
Prefix:DR
First Name:JEAN
Middle Name:S
Last Name:BENSON
Suffix:
Gender:F
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:PO BOX 468
Mailing Address - Street 2:
Mailing Address - City:SKOWHEGAN
Mailing Address - State:ME
Mailing Address - Zip Code:04976-0468
Mailing Address - Country:US
Mailing Address - Phone:207-474-5121
Mailing Address - Fax:
Practice Address - Street 1:173 MIDDLE ST
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:NH
Practice Address - Zip Code:03584-3508
Practice Address - Country:US
Practice Address - Phone:603-788-4911
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-21
Last Update Date:2021-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH15280207P00000X
MEMD14059207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME024823OtherANTHEM STAR NUMBER
ME1042511OtherAETNA HMO
ME1558367995Medicaid
NH32001280Medicaid
ME5976606OtherAETNA POS
ME080116794OtherRAILROAD MEDICARE
VT1020050Medicaid
VT1020050Medicaid
ME338870099Medicaid
ME024823OtherANTHEM STAR NUMBER
MEG27755Medicare UPIN