Provider Demographics
NPI:1558469791
Name:JOSEPH L BENOIT M D P A
Entity Type:Organization
Organization Name:JOSEPH L BENOIT M D P A
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:LAWRENCE
Authorized Official - Last Name:BENOIT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:207-990-1615
Mailing Address - Street 1:700 MOUNT HOPE AVE
Mailing Address - Street 2:SUITE 480
Mailing Address - City:BANGOR
Mailing Address - State:ME
Mailing Address - Zip Code:04401-5691
Mailing Address - Country:US
Mailing Address - Phone:207-990-1615
Mailing Address - Fax:207-990-5997
Practice Address - Street 1:700 MOUNT HOPE AVE
Practice Address - Street 2:SUITE 480
Practice Address - City:BANGOR
Practice Address - State:ME
Practice Address - Zip Code:04401-5691
Practice Address - Country:US
Practice Address - Phone:207-990-1615
Practice Address - Fax:207-990-5997
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2011-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME011974207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME127240099Medicaid
MEMM0507Medicare ID - Type Unspecified
ME127240099Medicaid