Provider Demographics
NPI:1639370976
Name:JONATHAN A BENJAMIN, MD & ROGER W SPINGARN, MD
Entity Type:Organization
Organization Name:JONATHAN A BENJAMIN, MD & ROGER W SPINGARN, MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:A
Authorized Official - Last Name:BENJAMIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:617-244-9929
Mailing Address - Street 1:1400 CENTRE ST
Mailing Address - Street 2:SUITE 203
Mailing Address - City:NEWTON
Mailing Address - State:MA
Mailing Address - Zip Code:02459-2454
Mailing Address - Country:US
Mailing Address - Phone:617-244-9929
Mailing Address - Fax:617-244-9935
Practice Address - Street 1:1400 CENTRE ST
Practice Address - Street 2:SUITE 203
Practice Address - City:NEWTON
Practice Address - State:MA
Practice Address - Zip Code:02459-2454
Practice Address - Country:US
Practice Address - Phone:617-244-9929
Practice Address - Fax:617-244-9935
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-31
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA47711208000000X
MA215848208000000X
MA775732080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
Not Answered2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAM16851OtherBCBS
MA615204OtherTUFTS HEALTH PLAN
MA9706887Medicaid