Healthcare Provider Details

I. General information

NPI: 1639370976
Provider Name (Legal Business Name): JONATHAN A BENJAMIN, MD & ROGER W SPINGARN, MD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/31/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 CENTRE ST SUITE 203
NEWTON MA
02459-2454
US

IV. Provider business mailing address

1400 CENTRE ST SUITE 203
NEWTON MA
02459-2454
US

V. Phone/Fax

Practice location:
  • Phone: 617-244-9929
  • Fax: 617-244-9935
Mailing address:
  • Phone: 617-244-9929
  • Fax: 617-244-9935

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number47711
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number215848
License Number StateMA
# 3
Primary TaxonomyY
Taxonomy Code2080A0000X
TaxonomyPediatric Adolescent Medicine Physician
License Number77573
License Number StateMA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
IdentifierM16851
Identifier TypeOTHER
Identifier StateMA
Identifier IssuerBCBS
# 2
Identifier615204
Identifier TypeOTHER
Identifier StateMA
Identifier IssuerTUFTS HEALTH PLAN
# 3
Identifier9706887
Identifier TypeMEDICAID
Identifier StateMA
Identifier Issuer

VIII. Authorized Official

Name: DR. JONATHAN A BENJAMIN
Title or Position: MANAGING PARTNER
Credential: MD
Phone: 617-244-9929