Provider Demographics
NPI:1144391079
Name:BENTIVEGNA, PETER EDWARD (MD)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:EDWARD
Last Name:BENTIVEGNA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 ANSEL HALLET RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:WEST YARMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02673-2582
Mailing Address - Country:US
Mailing Address - Phone:508-771-4263
Mailing Address - Fax:508-771-7906
Practice Address - Street 1:150 ANSEL HALLET RD
Practice Address - Street 2:SUITE A
Practice Address - City:WEST YARMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02673-2582
Practice Address - Country:US
Practice Address - Phone:508-771-4263
Practice Address - Fax:508-771-7906
Is Sole Proprietor?:No
Enumeration Date:2006-11-13
Last Update Date:2008-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA76228208200000X, 2082S0105X, 2086S0105X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
No2082S0105XAllopathic & Osteopathic PhysiciansPlastic SurgerySurgery of the Hand
No2086S0105XAllopathic & Osteopathic PhysiciansSurgerySurgery of the Hand
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAAA58432OtherHARVARD PILGRIM
MAJ12891OtherBLUE CROSS BLUE SHIELD
MA737491OtherTUFTS HEALTH PLANS
MAJ12891OtherBLUE CROSS BLUE SHIELD
MAAA58432OtherHARVARD PILGRIM