Healthcare Provider Details

I. General information

NPI: 1346231529
Provider Name (Legal Business Name): ROBERT R BENNER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/04/2005
Last Update Date: 05/22/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

777 NORTH ST SUITE 301
PITTSFIELD MA
01201
US

IV. Provider business mailing address

777 NORTH STREET
PITTSFIELD MA
01201
US

V. Phone/Fax

Practice location:
  • Phone: 413-499-8570
  • Fax: 413-499-8565
Mailing address:
  • Phone: 413-499-8570
  • Fax: 413-499-8565

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number75676
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: