Provider Demographics
NPI:1457379703
Name:MAHLAB, BENJAMIN EDWARD (MD)
Entity Type:Individual
Prefix:DR
First Name:BENJAMIN
Middle Name:EDWARD
Last Name:MAHLAB
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1 MEDICAL CENTER DR
Mailing Address - Street 2:DHMC - DEPARTMENT OF OB - GYN
Mailing Address - City:LEBANON
Mailing Address - State:NH
Mailing Address - Zip Code:03756-1000
Mailing Address - Country:US
Mailing Address - Phone:603-653-9314
Mailing Address - Fax:603-650-0901
Practice Address - Street 1:1 MEDICAL CENTER DR
Practice Address - Street 2:DHMC - DEPARTMENT OF OB - GYN
Practice Address - City:LEBANON
Practice Address - State:NH
Practice Address - Zip Code:03756-1000
Practice Address - Country:US
Practice Address - Phone:603-653-9314
Practice Address - Fax:603-650-0901
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2011-08-31
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NH8220207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT1002976Medicaid
NH30003421Medicaid
NHDX4070Medicare PIN
E75662Medicare UPIN