Provider Demographics
NPI:1831275684
Name:ELLEN J. BENTLEY, M.D., P.A.
Entity type:Organization
Organization Name:ELLEN J. BENTLEY, M.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ELLEN
Authorized Official - Middle Name:J
Authorized Official - Last Name:BENTLEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:207-945-4300
Mailing Address - Street 1:700 MOUNT HOPE AVE
Mailing Address - Street 2:SUITE 430
Mailing Address - City:BANGOR
Mailing Address - State:ME
Mailing Address - Zip Code:04401-5691
Mailing Address - Country:US
Mailing Address - Phone:207-945-4300
Mailing Address - Fax:207-945-0755
Practice Address - Street 1:700 MOUNT HOPE AVE
Practice Address - Street 2:SUITE 430
Practice Address - City:BANGOR
Practice Address - State:ME
Practice Address - Zip Code:04401-5691
Practice Address - Country:US
Practice Address - Phone:207-945-4300
Practice Address - Fax:207-945-0755
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-27
Last Update Date:2014-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME013186207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME2645719OtherAETNA IND
ME041320OtherANTHEM
MEM7321OtherCIGNA
ME135340000Medicaid
MEM7321OtherCIGNA
MEMM3932Medicare ID - Type UnspecifiedMEDICARE
MEM7321OtherCIGNA