=====================================================
General NPI Number Information
=====================================================
NPI Number | 1265489371
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | BENEDITO A. CARNEIRO MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/27/2006
-----------------------------------------------------
Last Update Date | 12/09/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 164 SUMMIT AVE
-----------------------------------------------------
City | PROVIDENCE
-----------------------------------------------------
State | RI
-----------------------------------------------------
Zip | 02906-2853
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 401-793-7151
-----------------------------------------------------
Fax | 401-793-7132
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 164 SUMMIT AVE
-----------------------------------------------------
City | PROVIDENCE
-----------------------------------------------------
State | RI
-----------------------------------------------------
Zip | 02906-2853
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 401-793-7151
-----------------------------------------------------
Fax | 401-793-7132
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RX0202X
-----------------------------------------------------
Taxonomy Name | Medical Oncology Physician
-----------------------------------------------------
License Number | 036115617
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207RX0202X
-----------------------------------------------------
Taxonomy Name | Medical Oncology Physician
-----------------------------------------------------
License Number | MD15932
-----------------------------------------------------
License Number State | RI
-----------------------------------------------------