Healthcare Provider Details

I. General information

NPI: 1942479860
Provider Name (Legal Business Name): JOSEPH DIBENEDETTO JR MD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/25/2008
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 NumberMD004989
License Number StateRI

VIII. Authorized Official

Name: PATRICIA W. DIBENEDETTO
Title or Position: RN,BSN,OCN, PRACTICE MANAGER
Credential:
Phone: 401-351-4470