Healthcare Provider Details

I. General information

NPI: 1659511541
Provider Name (Legal Business Name): RODRIGO ALBERTO BENAVIDES CORDERO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/04/2009
Last Update Date: 12/03/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

75 FRANCIS ST DEPARTMENT OF ANESTHESIOLOGY BWH
BOSTON MA
02115-6110
US

IV. Provider business mailing address

75 FRANCIS ST DEPARTMENT OF ANESTHESIOLOGY BWH
BOSTON MA
02115-6110
US

V. Phone/Fax

Practice location:
  • Phone: 617-732-8218
  • Fax: 617-582-6131
Mailing address:
  • Phone: 617-732-8218
  • Fax: 617-582-6131

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number35120419
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: