Provider Demographics
NPI:1982690491
Name:TIPTON, BENJAMIN V (MPA-C)
Entity Type:Individual
Prefix:MR
First Name:BENJAMIN
Middle Name:V
Last Name:TIPTON
Suffix:
Gender:M
Credentials:MPA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:108 CENTRE ST
Mailing Address - Street 2:MIDCOAST MEDICAL GROUP
Mailing Address - City:BATH
Mailing Address - State:ME
Mailing Address - Zip Code:04530-2550
Mailing Address - Country:US
Mailing Address - Phone:207-386-1800
Mailing Address - Fax:207-386-1801
Practice Address - Street 1:108 CENTRE ST
Practice Address - Street 2:MIDCOAST MEDICAL GROUP
Practice Address - City:BATH
Practice Address - State:ME
Practice Address - Zip Code:04530-2550
Practice Address - Country:US
Practice Address - Phone:207-386-1800
Practice Address - Fax:207-386-1801
Is Sole Proprietor?:No
Enumeration Date:2005-09-21
Last Update Date:2015-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPA001117363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME432800299Medicaid
ME432800299Medicaid
ME0003738Medicare PIN
ME0003738Medicare PIN