Provider Demographics
NPI:1366470288
Name:BENOIT, RONNIE S (MD)
Entity Type:Individual
Prefix:DR
First Name:RONNIE
Middle Name:S
Last Name:BENOIT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:230 N BROAD ST
Mailing Address - Street 2:TPSIV OF PA, LLC
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19102-1121
Mailing Address - Country:US
Mailing Address - Phone:215-762-2010
Mailing Address - Fax:215-246-5971
Practice Address - Street 1:230 N BROAD ST
Practice Address - Street 2:TPSIV OF PA, LLC
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19102-1121
Practice Address - Country:US
Practice Address - Phone:215-762-2010
Practice Address - Fax:215-246-5971
Is Sole Proprietor?:No
Enumeration Date:2006-06-29
Last Update Date:2011-03-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0101057816208600000X
PAMD4372492086S0127X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0127XAllopathic & Osteopathic PhysiciansSurgeryTrauma Surgery
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC014950I83Medicare PIN
G41508Medicare UPIN