Provider Demographics
NPI:1760452635
Name:BENEITONE, ROGER J (MD)
Entity Type:Individual
Prefix:DR
First Name:ROGER
Middle Name:J
Last Name:BENEITONE
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 1:280 CHESTNUT STREET
Mailing Address - Street 2:2ND FL
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01199-1001
Mailing Address - Country:US
Mailing Address - Phone:413-794-5700
Mailing Address - Fax:
Practice Address - Street 1:57 UNION STREET
Practice Address - Street 2:
Practice Address - City:WESTFIELD
Practice Address - State:MA
Practice Address - Zip Code:01085-2658
Practice Address - Country:US
Practice Address - Phone:413-572-6050
Practice Address - Fax:413-568-1097
Is Sole Proprietor?:No
Enumeration Date:2006-01-24
Last Update Date:2019-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA54328207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAP00306922OtherRR MEDICARE
MA110065991/AMedicaid
MA110065991/AMedicaid