| Benjamin Crocker Md | |
|
208 Vaughan St Portland ME 04102-3204 | |
| (207) 400-6197 | |
| (888) 232-0290 |
| Full Name | Benjamin Crocker Md |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 208 Vaughan St, Portland, Maine |
| Authorized Official Name and Position | Benjamin Crocker (OWNER) |
| Authorized Official Contact | 2074508627 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Benjamin Crocker Md 13 Carroll St Portland ME 04102-3501 Ph: (207) 400-6197 | Benjamin Crocker Md 208 Vaughan St Portland ME 04102-3204 Ph: (207) 400-6197 |
| NPI Number | 1417315482 |
|---|---|
| Provider Enumeration Date | 02/05/2016 |
| Last Update Date | 05/31/2022 |
| Certification Date | 05/31/2022 |
| Medicare PECOS PAC ID | 0244528933 |
|---|---|
| Medicare Enrollment ID | O20161012002366 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1417315482 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084P0800X | Psychiatry & Neurology - Psychiatry | MD13127 (Maine) | Primary |
| Provider Name | Benjamin Crocker |
|---|---|
| Provider Type | Practitioner - Neuropsychiatry |
| Provider Identifiers | NPI Number: 1841297009 PECOS PAC ID: 2466427604 Enrollment ID: I20040831000787 |
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