Healthcare Provider Details

I. General information

NPI: 1235196601
Provider Name (Legal Business Name): PETER ALAN BENN D.SC.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 04/28/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

38 METACOMET RD
FARMINGTON CT
06032-1801
US

IV. Provider business mailing address

38 METACOMET RD
FARMINGTON CT
06032-1801
US

V. Phone/Fax

Practice location:
  • Phone: 860-677-6743
  • Fax:
Mailing address:
  • Phone: 860-677-6743
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code170100000X
TaxonomyPh.D. Medical Genetics
License Number
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: