Provider Demographics
NPI:1023014487
Name:BENEDETTO, BERNARD J (MD)
Entity Type:Individual
Prefix:MR
First Name:BERNARD
Middle Name:J
Last Name:BENEDETTO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:104 ENDICOTT ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:DANVERS
Mailing Address - State:MA
Mailing Address - Zip Code:01923-3623
Mailing Address - Country:US
Mailing Address - Phone:978-882-6868
Mailing Address - Fax:978-882-6828
Practice Address - Street 1:330 BORTHWICK AVE STE 308
Practice Address - Street 2:
Practice Address - City:PORTSMOUTH
Practice Address - State:NH
Practice Address - Zip Code:03801-7112
Practice Address - Country:US
Practice Address - Phone:603-431-5242
Practice Address - Fax:603-431-5091
Is Sole Proprietor?:No
Enumeration Date:2005-06-21
Last Update Date:2020-06-29
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MA236697208600000X
RIMD11776208600000X
RI117762086S0102X
NH19048208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No2086S0102XAllopathic & Osteopathic PhysiciansSurgerySurgical Critical Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA2102811Medicaid
RB6307Medicare PIN
MA2102811Medicaid