Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207V00000X | Obstetrician & Gynecologist | 217837 | MA |
Y | 207VE0102X | Reproductive Endocrinologist | 231397 | MA |
NPI | 1225170624 |
---|---|
Provider Name | Benjamin Michael Lannon |
First Address | South Portland, ME 04106-5447 |
Second Address | South Portland, ME 04106-5447 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/02/2007 |
Last Update Date | 29/07/2011 |