Healthcare Provider Details

I. General information

NPI: 1073142527
Provider Name (Legal Business Name): STACEY ELIZABETH BENBEN DO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/06/2020
Last Update Date: 07/06/2026
Certification Date: 07/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7 CENTRAL ST
PROVIDENCE RI
02907-2201
US

IV. Provider business mailing address

7 CENTRAL ST
PROVIDENCE RI
02907-2201
US

V. Phone/Fax

Practice location:
  • Phone: 401-648-4700
  • Fax:
Mailing address:
  • Phone: 401-648-4700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberDO01561
License Number StateRI
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number1026759
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: