Healthcare Provider Details

I. General information

NPI: 1285048538
Provider Name (Legal Business Name): LUCAS MEIRA BENCHAYA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2014
Last Update Date: 07/09/2024
Certification Date: 07/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

80 SEYMOUR ST # JB604
HARTFORD CT
06102-8000
US

IV. Provider business mailing address

80 SEYMOUR ST # JB604
HARTFORD CT
06102-8000
US

V. Phone/Fax

Practice location:
  • Phone: 860-751-4601
  • Fax:
Mailing address:
  • Phone: 860-751-4601
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0008X
TaxonomyNeuromuscular Medicine (Psychiatry & Neurology) Physician
License Number61811
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: