Healthcare Provider Details

I. General information

NPI: 1619941648
Provider Name (Legal Business Name): ELIZABETH M BENJEVIN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/15/2006
Last Update Date: 10/23/2025
Certification Date: 10/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24 ASH CIR
HOLDEN MA
01520-1161
US

IV. Provider business mailing address

24 ASH CIR
HOLDEN MA
01520-1161
US

V. Phone/Fax

Practice location:
  • Phone: 508-829-8838
  • Fax:
Mailing address:
  • Phone: 508-829-8838
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number57532
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: