Provider Demographics
NPI:1568427607
Name:VALENTINE, BENEDICT CHARLES II (DPM)
Entity Type:Individual
Prefix:DR
First Name:BENEDICT
Middle Name:CHARLES
Last Name:VALENTINE
Suffix:II
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:8 INDEPENDENCE DR
Mailing Address - Street 2:
Mailing Address - City:MARLBOROUGH
Mailing Address - State:CT
Mailing Address - Zip Code:06447-1408
Mailing Address - Country:US
Mailing Address - Phone:860-295-9179
Mailing Address - Fax:860-295-9184
Practice Address - Street 1:8 INDEPENDENCE DR
Practice Address - Street 2:
Practice Address - City:MARLBOROUGH
Practice Address - State:CT
Practice Address - Zip Code:06447-1408
Practice Address - Country:US
Practice Address - Phone:860-295-9179
Practice Address - Fax:860-295-9184
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000644213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTT89842Medicare UPIN