Provider Demographics
NPI:1205820727
Name:BENTON, ROBERT E (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:E
Last Name:BENTON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:7 SOUTHWOODS BLVD
Mailing Address - Street 2:CAPITAL CARDIOLOGY ASSOCIATES PC
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12211-2526
Mailing Address - Country:US
Mailing Address - Phone:518-292-6000
Mailing Address - Fax:518-292-6050
Practice Address - Street 1:2231 BURDETT AVE
Practice Address - Street 2:#160 CAPITAL CARDIOLOGY ASSOCIATES PC
Practice Address - City:TROY
Practice Address - State:NY
Practice Address - Zip Code:12180-2466
Practice Address - Country:US
Practice Address - Phone:518-292-6200
Practice Address - Fax:518-292-6228
Is Sole Proprietor?:No
Enumeration Date:2005-09-12
Last Update Date:2015-01-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY175324207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA2011646Medicaid
NY01830780Medicaid
NY060067419OtherRR MEDICARE
VT1007042Medicaid
MA2011646Medicaid
NYCC8760Medicare PIN