Healthcare Provider Details

I. General information

NPI: 1831388552
Provider Name (Legal Business Name): BENJAMIN C DICKERT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/18/2007
Last Update Date: 03/28/2024
Certification Date: 03/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

222 CAREW ST STE 101
SPRINGFIELD MA
01104-4105
US

IV. Provider business mailing address

222 CAREW ST STE 101
SPRINGFIELD MA
01104-4105
US

V. Phone/Fax

Practice location:
  • Phone: 413-736-3225
  • Fax: 413-736-3382
Mailing address:
  • Phone: 413-736-3225
  • Fax: 413-736-3382

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License NumberPD1884
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number
License Number State

VIII. Authorized Official

Name: BENJAMIN C. DICKERT
Title or Position: OWNER
Credential: D.P.M.
Phone: 413-736-3225