Individual
MARIAN BENNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
360 BROADWAY, BANGOR, ME 04401-3979
(207) 907-1550
(207) 907-3052
Mailing address
C/O ST MARYS HEALTH SYSTEM - PROVIDER ENROLLMENT, PO BOX 7291, LEWISTON, ME 04243-7291
(207) 777-8560
(207) 777-8800
Taxonomy
Speciality
Code
Description
License number
State
207PE0005X
Undersea and Hyperbaric Medicine (Emergency Medicine) Physician
Primary
MD16834
ME
207R00000X
Internal Medicine Physician
MD16834
ME
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
528951300
—
ME
Enumeration date
11/13/2006
Last updated
02/03/2022
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