Provider Demographics
NPI:1407834989
Name:FAITELSON, BENJAMIN BENTLEY (MD)
Entity Type:Individual
Prefix:DR
First Name:BENJAMIN
Middle Name:BENTLEY
Last Name:FAITELSON
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 1:105 HAWTHORNE VILLAGE RD
Mailing Address - Street 2:
Mailing Address - City:NASHUA
Mailing Address - State:NH
Mailing Address - Zip Code:03062-2277
Mailing Address - Country:US
Mailing Address - Phone:603-888-4664
Mailing Address - Fax:603-888-4664
Practice Address - Street 1:6 TSIENNETO RD STE 100LL
Practice Address - Street 2:
Practice Address - City:DERRY
Practice Address - State:NH
Practice Address - Zip Code:03038-1584
Practice Address - Country:US
Practice Address - Phone:603-883-4636
Practice Address - Fax:603-883-6854
Is Sole Proprietor?:No
Enumeration Date:2006-01-05
Last Update Date:2022-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH108632085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH80001601Medicaid
NHRE1601Medicare ID - Type Unspecified
NHF21654Medicare UPIN