Provider Demographics
NPI:1649378332
Name:THOMPSON, BENJAMIN M (MD)
Entity type:Individual
Prefix:DR
First Name:BENJAMIN
Middle Name:M
Last Name:THOMPSON
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 1:68 LOVEITTS FIELD RD
Mailing Address - Street 2:
Mailing Address - City:SOUTH PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04106-5123
Mailing Address - Country:US
Mailing Address - Phone:207-799-3965
Mailing Address - Fax:
Practice Address - Street 1:202 US ROUTE 1
Practice Address - Street 2:TRUE NORTH
Practice Address - City:FALMOUTH
Practice Address - State:ME
Practice Address - Zip Code:04105-1327
Practice Address - Country:US
Practice Address - Phone:207-871-4488
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME011789207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VTOVN1250Medicaid
VT28465OtherBLUE CROSS/ BLUE SHIELD
VTVN1250Medicare ID - Type Unspecified
VT28465OtherBLUE CROSS/ BLUE SHIELD