MEDICARE: BENJAMIN JOHN LANDIS MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2080P0202X	Pediatric Cardiology Physician	82414	CT

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1699928739
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BENJAMIN JOHN LANDIS MD

Provider Business Mailing Address
First Line	:	PO BOX 208064
Second Line	:
City	:	NEW HAVEN
State	:	CT
Zip	:	06520-8064
Country	:	US
Telephone Number	:	203-785-2022
Fax Number	:	203-737-2786

Provider Business Practice Location Address
First Line	:	330 CEDAR ST STE LMP 4085
Second Line	:
City	:	NEW HAVEN
State	:	CT
Zip	:	06510-3218
Country	:	US
Telephone Number	:	203-785-2022
Fax Number	:	203-737-2786

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/03/2008
Last Update Date	:	10/20/2025

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