Provider Demographics
NPI:1205820222
Name:DIBENEDETTO, JOSEPH JR (MD)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:
Last Name:DIBENEDETTO
Suffix:JR
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 1:193 WATERMAN ST
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02906-4014
Mailing Address - Country:US
Mailing Address - Phone:401-351-4470
Mailing Address - Fax:401-351-0163
Practice Address - Street 1:193 WATERMAN ST
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02906-4014
Practice Address - Country:US
Practice Address - Phone:401-351-4470
Practice Address - Fax:401-351-0163
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-06
Last Update Date:2008-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RI4989207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI9019RIHOtherHARVARD PILGRIM HEALTH #
RI000644OtherBLUE CHIP ID 3
RI30-00103OtherUNITED HEALTH PROVIDER #
5284224OtherAETNA
RIRIH9019OtherHARVARD PILGRIM HEALTH #
RI369-0OtherBLUE CROSS PROVIDER #
RI9000369Medicaid
RI9000369Medicaid
RIC90696Medicare UPIN