Provider Demographics
NPI:1952183550
Name:SCHWINK-ZANELLA, BENJAMIN (PHYSICIAN ASSISTANT)
Entity Type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:
Last Name:SCHWINK-ZANELLA
Suffix:
Gender:M
Credentials:PHYSICIAN ASSISTANT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:592 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WALDOBORO
Mailing Address - State:ME
Mailing Address - Zip Code:04572-6030
Mailing Address - Country:US
Mailing Address - Phone:207-832-6394
Mailing Address - Fax:207-832-4392
Practice Address - Street 1:592 W MAIN ST
Practice Address - Street 2:
Practice Address - City:WALDOBORO
Practice Address - State:ME
Practice Address - Zip Code:04572-6030
Practice Address - Country:US
Practice Address - Phone:207-832-6394
Practice Address - Fax:207-832-4392
Is Sole Proprietor?:No
Enumeration Date:2023-10-18
Last Update Date:2023-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPA2597363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MEPA2597OtherMAINE BOARD OF LICENSURE IN MEDICINE