Provider Demographics
NPI:1972663300
Name:BENNETT, WILLIAM (MD)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:
Last Name:BENNETT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:325 KENNEDY MEMORIAL DR # C
Mailing Address - Street 2:
Mailing Address - City:WATERVILLE
Mailing Address - State:ME
Mailing Address - Zip Code:04901-4517
Mailing Address - Country:US
Mailing Address - Phone:207-872-9511
Mailing Address - Fax:207-861-5466
Practice Address - Street 1:325 KENNEDY MEMORIAL DR # C
Practice Address - Street 2:
Practice Address - City:WATERVILLE
Practice Address - State:ME
Practice Address - Zip Code:04901-4517
Practice Address - Country:US
Practice Address - Phone:207-872-9511
Practice Address - Fax:207-861-5466
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-08
Last Update Date:2008-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME007873207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
M53261OtherCIGNA
ME135660099Medicaid
000948OtherANTHEM
P00223084OtherRAILROAD MEDICARE
ME135660099Medicaid
MED93055Medicare UPIN