Provider Demographics
NPI:1356307789
Name:BENZULY, SCOTT E (MD)
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:E
Last Name:BENZULY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:ONE VIRGINIA AVENUE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02905
Mailing Address - Country:US
Mailing Address - Phone:401-490-0916
Mailing Address - Fax:401-490-0979
Practice Address - Street 1:593 EDDY STREET
Practice Address - Street 2:DAVOL 129
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02903-4923
Practice Address - Country:US
Practice Address - Phone:401-444-4933
Practice Address - Fax:401-444-5090
Is Sole Proprietor?:No
Enumeration Date:2006-04-25
Last Update Date:2023-02-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
RIMD10796207L00000X, 207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI7009535Medicaid
RI007009535Medicare ID - Type UnspecifiedPROVIDER NUMBER
RI7009535Medicaid