Provider Demographics
NPI:1265489371
Name:CARNEIRO FILHO, BENEDITO A (MD)
Entity Type:Individual
Prefix:DR
First Name:BENEDITO
Middle Name:A
Last Name:CARNEIRO FILHO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:BENEDITO
Other - Middle Name:
Other - Last Name:CARNEIRO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:164 SUMMIT AVE
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02906-2853
Mailing Address - Country:US
Mailing Address - Phone:401-793-7151
Mailing Address - Fax:401-793-7132
Practice Address - Street 1:164 SUMMIT AVE
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02906-2853
Practice Address - Country:US
Practice Address - Phone:401-793-7151
Practice Address - Fax:401-793-7132
Is Sole Proprietor?:No
Enumeration Date:2006-05-27
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036115617207RX0202X
RIMD15932207RX0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036115617OtherIL STATE LICENSE
RIMD15932OtherRI MEDICAL STATE LICENSE