Healthcare Provider Details

I. General information

NPI: 1205820222
Provider Name (Legal Business Name): JOSEPH DIBENEDETTO JR. MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/06/2005
Last Update Date: 05/28/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

193 WATERMAN ST
PROVIDENCE RI
02906-4014
US

IV. Provider business mailing address

193 WATERMAN ST
PROVIDENCE RI
02906-4014
US

V. Phone/Fax

Practice location:
  • Phone: 401-351-4470
  • Fax: 401-351-0163
Mailing address:
  • Phone: 401-351-4470
  • Fax: 401-351-0163

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number4989
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: