Provider Demographics
NPI:1811956931
Name:BENNETT, CHRISTINE A (MD)
Entity type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:A
Last Name:BENNETT
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:100 FODEN ROAD , WEST
Mailing Address - Street 2:SUITE 203
Mailing Address - City:SOUTH PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04106
Mailing Address - Country:US
Mailing Address - Phone:207-828-0361
Mailing Address - Fax:207-874-1483
Practice Address - Street 1:84 MARGINAL WAY
Practice Address - Street 2:SUITE 1000
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04101-2443
Practice Address - Country:US
Practice Address - Phone:207-774-4092
Practice Address - Fax:207-523-8596
Is Sole Proprietor?:No
Enumeration Date:2006-03-18
Last Update Date:2010-10-14
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Provider Licenses
StateLicense IDTaxonomies
ME013057208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
1040753OtherAETNA
ME218250099Medicaid
010928OtherANTHEM