Provider Demographics
NPI:1346231529
Name:BENNER, ROBERT R (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:R
Last Name:BENNER
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 1:777 NORTH STREET
Mailing Address - Street 2:
Mailing Address - City:PITTSFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01201
Mailing Address - Country:US
Mailing Address - Phone:413-499-8570
Mailing Address - Fax:413-499-8565
Practice Address - Street 1:777 NORTH ST
Practice Address - Street 2:SUITE 301
Practice Address - City:PITTSFIELD
Practice Address - State:MA
Practice Address - Zip Code:01201
Practice Address - Country:US
Practice Address - Phone:413-499-8570
Practice Address - Fax:413-499-8565
Is Sole Proprietor?:No
Enumeration Date:2005-11-04
Last Update Date:2017-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA75676207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
043517461OtherCIGNA
043517461OtherNO AMERICAN ADMIN
10540OtherHEATH NEW ENGLAND
153344OtherMVP SELECT
J12595OtherBLUE SHIELD
000000022178OtherBMC HEALTH NET PLAN
80314OtherGIC INDEMNITY PLAN
043517461OtherHCVM FIRST HEALTH
043517461OtherCHAMPUS
043517461OtherHMC PPO
MA3094561Medicaid
0000799OtherNEIGHBORHOOD HEALTH PLAN
160052693OtherMEDICARE RAILROAD
32596OtherHEALTHY START
10034446OtherCAPITAL DISTRICT PHP
2345333OtherAETNA
F29387OtherHARVARD COMM HEALTH
J12595OtherHMO BLUE
MAJ12595Medicare ID - Type Unspecified
F29387Medicare UPIN