Healthcare Provider Details

I. General information

NPI: 1174752448
Provider Name (Legal Business Name): RICHARD E BENETTI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/08/2009
Last Update Date: 10/21/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

88 MONTVALE AVE SUITE 3
STONEHAM MA
02180-3643
US

IV. Provider business mailing address

88 MONTVALE AVE SUITE 3
STONEHAM MA
02180-3643
US

V. Phone/Fax

Practice location:
  • Phone: 781-481-9255
  • Fax: 781-481-9257
Mailing address:
  • Phone: 781-481-9255
  • Fax: 781-481-9257

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number253301
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: