Provider Demographics
NPI:1285660308
Name:BENZONI, LUCIA CATHERINE (DO)
Entity Type:Individual
Prefix:
First Name:LUCIA
Middle Name:CATHERINE
Last Name:BENZONI
Suffix:
Gender:F
Credentials:DO
Other - Prefix:MRS
Other - First Name:LUCIA
Other - Middle Name:CATHERINE
Other - Last Name:BENZONI-DIECK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DO
Mailing Address - Street 1:PO BOX 427
Mailing Address - Street 2:
Mailing Address - City:LITCHFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06759-0427
Mailing Address - Country:US
Mailing Address - Phone:860-567-1263
Mailing Address - Fax:
Practice Address - Street 1:622 BANTAM RD
Practice Address - Street 2:
Practice Address - City:BANTAM
Practice Address - State:CT
Practice Address - Zip Code:06750-1600
Practice Address - Country:US
Practice Address - Phone:860-567-1263
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-23
Last Update Date:2012-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000519208M00000X, 207R00000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001005190Medicaid
G39698Medicare UPIN