Provider Demographics
NPI:1154398089
Name:HIERONYMUS, BEN THOMAS JR (ARNPC)
Entity type:Individual
Prefix:
First Name:BEN
Middle Name:THOMAS
Last Name:HIERONYMUS
Suffix:JR
Gender:M
Credentials:ARNPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX J
Mailing Address - Street 2:
Mailing Address - City:NEWPORT
Mailing Address - State:ME
Mailing Address - Zip Code:04953
Mailing Address - Country:US
Mailing Address - Phone:207-368-5747
Mailing Address - Fax:207-368-5483
Practice Address - Street 1:26 MAIN ST
Practice Address - Street 2:STE 2
Practice Address - City:NEWPORT
Practice Address - State:ME
Practice Address - Zip Code:04953
Practice Address - Country:US
Practice Address - Phone:207-368-5747
Practice Address - Fax:207-368-5483
Is Sole Proprietor?:No
Enumeration Date:2006-02-28
Last Update Date:2019-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MER046445363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME327010099Medicaid
ME327010099Medicaid
P42326Medicare UPIN