Provider Demographics
NPI:1679581847
Name:BENZONI, ELISA M (DO)
Entity Type:Individual
Prefix:
First Name:ELISA
Middle Name:M
Last Name:BENZONI
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:140 GRANDVIEW AVE
Mailing Address - Street 2:SUITE 202
Mailing Address - City:WATERBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06708-2505
Mailing Address - Country:US
Mailing Address - Phone:203-755-2344
Mailing Address - Fax:203-573-8166
Practice Address - Street 1:140 GRANDVIEW AVE
Practice Address - Street 2:SUITE 202
Practice Address - City:WATERBURY
Practice Address - State:CT
Practice Address - Zip Code:06708-2505
Practice Address - Country:US
Practice Address - Phone:203-755-2344
Practice Address - Fax:203-573-8166
Is Sole Proprietor?:No
Enumeration Date:2006-08-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000499207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT1739548OtherCIGNA PROVIDER #
CT0740449OtherUNITED HEALTHCARE #
CTP1012736OtherOXFORD PROVIDER #
CT000499OtherCONNECTICARE PROVIDER #
CT040000499CT01OtherANTHEM FAMILY PLAN #
CT040000499CT01OtherANTHEM PROVIDER #
CT139689OtherWELLCARE PROVIDER #
CT2198837OtherUS HEALTHCARE #
CTOV5743OtherHEALTHNET PROVIDER #
CT1739548OtherCIGNA PROVIDER #