Provider Demographics
NPI:1619941648
Name:BENJEVIN, ELIZABETH M (MD)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:M
Last Name:BENJEVIN
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:PO BOX 415348
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02241-5348
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:55 LAKE AVE N
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01655-0002
Practice Address - Country:US
Practice Address - Phone:774-443-3886
Practice Address - Fax:774-443-3913
Is Sole Proprietor?:No
Enumeration Date:2006-02-15
Last Update Date:2020-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA57532207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
J06798OtherBLUE SHIELD INDEMNITY
042472266OtherPRIVATE HEALTHCARE SYST
26725OtherCHILDRENS MED SEC PLAN
0100248OtherEVERCARE
042472266OtherONE HEALTH PLAN
MA110047185AMedicaid
080129483OtherRAILROAD MEDICARE
J06798OtherBLUE CARE ELECT
J06798OtherBLUE SHIELD HMO BLUE
6980911OtherCIGNA HEALTH PLAN
042472266OtherHEALTHCARE VALUE MGMT
4040531OtherAETNA
AA1184OtherHARVARD PILGRIM HLTHCARE
4040531OtherUS HEALTHCARE
917508OtherFIRST HEALTH
9900801OtherFALLON COMM HEALTH PLAN
J06798OtherBLUE SHIELD INDEMNITY
4040531OtherUS HEALTHCARE
J06798OtherBLUE SHIELD INDEMNITY
4040531OtherUS HEALTHCARE