Healthcare Provider Details

I. General information

NPI: 1619538808
Provider Name (Legal Business Name): OLIVIA BENZINO MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2019
Last Update Date: 07/28/2026
Certification Date: 07/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

133 BROOKLINE AVE
BOSTON MA
02215-3904
US

IV. Provider business mailing address

505 CONGRESS ST UNIT 814
BOSTON MA
02210-2907
US

V. Phone/Fax

Practice location:
  • Phone: 617-421-1000
  • Fax:
Mailing address:
  • Phone: 401-824-4935
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number1017964
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberLP04755
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: