Doctor Name: | BENJAMIN RANDALL |
NPI Number: | 1184089203 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | ATC |
License Number: | AT509 |
Business Practice Address: | 5747 Memorial Gym University Of Maine Orono, ME - 044690001 |
Business Phone Number: | 2075811088 |
Business Fax Number: | |
Mailing Address: | 5747 Memorial Gym University Of Maine, ORONO |
State: | ME |
Postal Code: | 044690001 |
Phone Number: | |
Fax Number: | |
NPI Enumeration Date: | 12/16/2015 |
NPI Last Update Date: | 12/16/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 246Z00000X |
License Number: | AT509 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | ME |
Taxonomy Type: | Technologists, Technicians & Other Technical Service Providers |
Taxonomy Classification: | Specialist/Technologist, Other |
Taxonomy Specialization: | |
Taxonomy Definition: | General classification identifying individuals trained on specific equipment and technical procedures in one of a collection of miscellaneous healthcare disciplines. |