Provider Demographics
NPI:1366545972
Name:MAILLOUX, BENJAMIN BRUCE (MD)
Entity type:Individual
Prefix:DR
First Name:BENJAMIN
Middle Name:BRUCE
Last Name:MAILLOUX
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:16 FAHEY ST
Mailing Address - Street 2:SUITE 103
Mailing Address - City:BELFAST
Mailing Address - State:ME
Mailing Address - Zip Code:04915
Mailing Address - Country:US
Mailing Address - Phone:207-338-5440
Mailing Address - Fax:207-338-6912
Practice Address - Street 1:16 FAHEY ST
Practice Address - Street 2:SUITE 103
Practice Address - City:BELFAST
Practice Address - State:ME
Practice Address - Zip Code:04915
Practice Address - Country:US
Practice Address - Phone:207-338-5440
Practice Address - Fax:207-338-6912
Is Sole Proprietor?:No
Enumeration Date:2006-09-07
Last Update Date:2010-01-14
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
ME018083207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
I69843Medicare PIN