Healthcare Provider Details

I. General information

NPI: 1174208458
Provider Name (Legal Business Name): BENJAMIN MORRIS EPPOLITO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2023
Last Update Date: 06/15/2026
Certification Date: 06/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

223 CHIEF JUSTICE CUSHING HWY STE 301
COHASSET MA
02025-1391
US

IV. Provider business mailing address

302 WEYMOUTH ST STE 202
ROCKLAND MA
02370-1172
US

V. Phone/Fax

Practice location:
  • Phone: 781-383-6261
  • Fax:
Mailing address:
  • Phone: 781-803-2786
  • Fax: 781-812-1631

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number0101283441
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number0116037915
License Number StateVA
# 3
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number1025714
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: