Provider Demographics
NPI:1679506117
Name:BENEDICTO, ALBERTO CARLOS (MD)
Entity Type:Individual
Prefix:DR
First Name:ALBERTO
Middle Name:CARLOS
Last Name:BENEDICTO
Suffix:
Gender:M
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 8000 DEPT 570
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14267-0002
Mailing Address - Country:US
Mailing Address - Phone:716-535-0741
Mailing Address - Fax:
Practice Address - Street 1:5300 MILITARY RD
Practice Address - Street 2:
Practice Address - City:LEWISTON
Practice Address - State:NY
Practice Address - Zip Code:14092-1903
Practice Address - Country:US
Practice Address - Phone:716-298-2356
Practice Address - Fax:716-298-2099
Is Sole Proprietor?:No
Enumeration Date:2006-07-08
Last Update Date:2024-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2262972085R0202X
OH35.0878982085R0202X
PAMD4388392085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY232588OtherPREFERRED CARE OF NY
NY2115334OtherINDEPENDENT HEALTH (IHA)
NY000530794001OtherBLUE CROSS BLUE SHIELD OF WESTERN NY
NY03024155Medicaid
NYP00658337OtherRAILROAD MEDICARE
NY090120000047OtherFIDELIS CARE OF NY
NYP00658337OtherRAILROAD MEDICARE