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General NPI Number Information
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NPI Number | 1174752448
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Entity Type | Individual
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Provider Name | RICHARD E BENETTI M.D.
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Gender | Male
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Dates
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Enumeration Date | 07/08/2009
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Last Update Date | 10/21/2016
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Provider Practice Location Address
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Address Line | 88 MONTVALE AVE SUITE 3
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City | STONEHAM
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State | MA
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Zip | 02180-3643
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Country | US
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Telephone | 781-481-9255
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Fax | 781-481-9257
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Provider Business Mailing Address
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Address Line | 88 MONTVALE AVE SUITE 3
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City | STONEHAM
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State | MA
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Zip | 02180-3643
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Country | US
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Telephone | 781-481-9255
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Fax | 781-481-9257
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 253301
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License Number State | MA
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