Provider Demographics
NPI:1104912864
Name:FARINO, BENEDICT J (MD)
Entity type:Individual
Prefix:
First Name:BENEDICT
Middle Name:J
Last Name:FARINO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:190 RIVERSIDE ST
Mailing Address - Street 2:SUITE 6B
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04103-1073
Mailing Address - Country:US
Mailing Address - Phone:207-661-2000
Mailing Address - Fax:
Practice Address - Street 1:96 CAMPUS DR
Practice Address - Street 2:SUITE 2B
Practice Address - City:SCARBOROUGH
Practice Address - State:ME
Practice Address - Zip Code:04074
Practice Address - Country:US
Practice Address - Phone:207-883-3491
Practice Address - Fax:207-885-5587
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2020-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEMD14732208M00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME268770099Medicaid
ME110175662Medicare PIN
G79007Medicare UPIN
ME268770099Medicaid
MEMM7452Medicare PIN
MEE400126694Medicare PIN
MEMX2266Medicare PIN
MEP00928548Medicare PIN
MEE400273405Medicare PIN