Provider Demographics
NPI:1760594469
Name:STUART H. BENTKOVER, MD PC
Entity Type:Organization
Organization Name:STUART H. BENTKOVER, MD PC
Other - Org Name:BENTKOVER FACIAL PLASTIC SURGERY&LASER CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:STUART
Authorized Official - Middle Name:HOWARD
Authorized Official - Last Name:BENTKOVER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:508-363-6500
Mailing Address - Street 1:123 SUMMER ST
Mailing Address - Street 2:SUIT 675
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01608-1216
Mailing Address - Country:US
Mailing Address - Phone:598-363-6500
Mailing Address - Fax:508-363-6501
Practice Address - Street 1:123 SUMMER ST
Practice Address - Street 2:SUIT 675
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01608-1216
Practice Address - Country:US
Practice Address - Phone:598-363-6500
Practice Address - Fax:508-363-6501
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2017-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA38152207YS0123X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207YS0123XAllopathic & Osteopathic PhysiciansOtolaryngologyFacial Plastic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA2039486Medicaid
MAB39143Medicare ID - Type Unspecified
MAA36101Medicare UPIN