Healthcare Provider Details

I. General information

NPI: 1962530691
Provider Name (Legal Business Name): JOSE LUIS BENITEZ M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/02/2007
Last Update Date: 09/17/2026
Certification Date: 09/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

546 MAIN ST
COVENTRY RI
02816-7852
US

IV. Provider business mailing address

2 FIELD OF DREAMS RD
COVENTRY RI
02827-1643
US

V. Phone/Fax

Practice location:
  • Phone: 401-821-6837
  • Fax:
Mailing address:
  • Phone: 401-688-6578
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number241352
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: