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Individual

DR. BENJAMIN LINCOLN RUSSELL

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
DO

Contact information

Practice address
195 FORE RIVER PKWY, SUITE 420, PORTLAND, ME 04102-2780
(207) 553-6500
(207) 553-6520
Mailing address
195 FORE RIVER PKWY, SUITE 420, PORTLAND, ME 04102-2780
(207) 553-6500
(207) 553-6520

Taxonomy

Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
1178
ME

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
245010099
ME
Enumeration date
07/13/2006
Last updated
02/10/2012
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