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Individual

DR. BENJAMIN CROCKER

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
208 VAUGHAN ST, PORTLAND, ME 04102-3204
(207) 450-8627
(888) 290-0232
Mailing address
208 VAUGHAN ST, PORTLAND, ME 04102-3204
(207) 450-8627
(888) 290-0232

Taxonomy

Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
G043952
CA
2084P0800X
Psychiatry Physician
Primary
MD13127
ME

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
273470099
ME
Enumeration date
07/02/2005
Last updated
02/02/2016
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