Basic Information
Provider Information
NPI: 1003006271
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: BENEZRA
FirstName: KAREN
MiddleName: M
NamePrefix: DR.
NameSuffix:  
Credential: D.O.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: PO BOX 827
Address2:  
City: KENNEBUNK
State: ME
PostalCode: 040430827
CountryCode: US
TelephoneNumber: 2076086864
FaxNumber: 8889724103
Practice Location
Address1: 62 PORTLAND RD STE 21
Address2:  
City: KENNEBUNK
State: ME
PostalCode: 040436650
CountryCode: US
TelephoneNumber: 2076086864
FaxNumber: 2075027211
Other Information
ProviderEnumerationDate: 07/25/2007
LastUpdateDate: 12/27/2013
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
204D00000X1900MEY Allopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine & OMM 
207Q00000X1900MEN Allopathic & Osteopathic PhysiciansFamily Medicine 

No ID Information.


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