Provider Demographics
NPI:1558405506
Name:BENOIT, MARILYN BARTOLO (MD)
Entity Type:Individual
Prefix:DR
First Name:MARILYN
Middle Name:BARTOLO
Last Name:BENOIT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1015 33RD ST NW
Mailing Address - Street 2:SUITE 115
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20007-3523
Mailing Address - Country:US
Mailing Address - Phone:202-607-3032
Mailing Address - Fax:202-363-4621
Practice Address - Street 1:1015 33RD ST NW
Practice Address - Street 2:SUITE 115
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20007-3523
Practice Address - Country:US
Practice Address - Phone:202-607-3032
Practice Address - Fax:202-363-4621
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC84692084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC0300040Medicaid