1861487761 NPI number — JOSEPH RALPH BENOTTI MD

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1861487761 NPI number — JOSEPH RALPH BENOTTI MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BENOTTI
Provider First Name:
JOSEPH
Provider Middle Name:
RALPH
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1861487761
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/25/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
123 SUMMER ST
Provider Second Line Business Mailing Address:
SUITE 660
Provider Business Mailing Address City Name:
WORCESTER
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
01608-1216
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
508-363-6330
Provider Business Mailing Address Fax Number:
508-363-7555

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
123 SUMMER ST
Provider Second Line Business Practice Location Address:
SUITE 660
Provider Business Practice Location Address City Name:
WORCESTER
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01608-1216
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
508-363-6330
Provider Business Practice Location Address Fax Number:
508-363-7555
Provider Enumeration Date:
09/16/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207RC0000X , with the licence number:  40836 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 2070189 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 300275 . This is a "HARVARD PILGRIM HEALTH CA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 45921 . This is a "FALLON HEALTH PLAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0022212 . This is a "NEIGHBORHOOD HEALTH PLAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 040836 . This is a "TUFTS HEALTH PLAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 25-00766 . This is a "UNITED HEALTHCARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 37986 . This is a "CIGNA HEALTHCARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 987754 . This is a "NETWORK HEALTH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 2294752 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 003069318 , issued by the state of ( CT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 060059416 . This is a "RR MC" identifier . This identifiers is of the category "OTHER".
  • Identifier: N01821 . This is a "BCBS OF MA" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".




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