Provider Demographics
NPI:1598954950
Name:DR. CONRAD H. BENOIT, PC
Entity Type:Organization
Organization Name:DR. CONRAD H. BENOIT, PC
Other - Org Name:OSTERVILLE INTERNAL MEDICINE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CONRAD
Authorized Official - Middle Name:HENRI
Authorized Official - Last Name:BENOIT
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:508-771-8114
Mailing Address - Street 1:PO BOX 278
Mailing Address - Street 2:
Mailing Address - City:OSTERVILLE
Mailing Address - State:MA
Mailing Address - Zip Code:02655-0278
Mailing Address - Country:US
Mailing Address - Phone:508-771-8114
Mailing Address - Fax:508-771-5822
Practice Address - Street 1:687 W MAIN ST
Practice Address - Street 2:
Practice Address - City:HYANNIS
Practice Address - State:MA
Practice Address - Zip Code:02601-3421
Practice Address - Country:US
Practice Address - Phone:508-771-8114
Practice Address - Fax:508-771-5822
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-22
Last Update Date:2012-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA74996207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAM17302OtherBLUE CROSS BLUE SHIELD
MAM21189Medicare PIN