Provider Demographics
NPI:1083762231
Name:FEELEY, BENJAMIN D (L AC, MAOM)
Entity Type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:D
Last Name:FEELEY
Suffix:
Gender:M
Credentials:L AC, MAOM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:36 FAIRVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:WATERTOWN
Mailing Address - State:MA
Mailing Address - Zip Code:02472-1222
Mailing Address - Country:US
Mailing Address - Phone:617-733-6921
Mailing Address - Fax:
Practice Address - Street 1:88 FAUNCE CORNER RD
Practice Address - Street 2:SUITE 210
Practice Address - City:N DARTMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02747-1261
Practice Address - Country:US
Practice Address - Phone:508-997-4158
Practice Address - Fax:508-997-3262
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA226509171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist