Provider Demographics
NPI:1679516181
Name:BENOIT, ANDRE JR (MD)
Entity type:Individual
Prefix:
First Name:ANDRE
Middle Name:
Last Name:BENOIT
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:50 UNION ST
Mailing Address - Street 2:
Mailing Address - City:ELLSWORTH
Mailing Address - State:ME
Mailing Address - Zip Code:04605-1534
Mailing Address - Country:US
Mailing Address - Phone:207-664-5513
Mailing Address - Fax:207-664-5515
Practice Address - Street 1:45 HERRICK RD
Practice Address - Street 2:
Practice Address - City:SOUTHWEST HARBOR
Practice Address - State:ME
Practice Address - Zip Code:04679-4433
Practice Address - Country:US
Practice Address - Phone:207-244-5513
Practice Address - Fax:207-664-5515
Is Sole Proprietor?:No
Enumeration Date:2006-06-13
Last Update Date:2015-10-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
ME009835207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME111770199Medicaid
ME01504001Medicare PIN
ME080079097Medicare PIN
ME015040Medicare PIN
MED78802Medicare UPIN