Provider Demographics
NPI:1861487761
Name:BENOTTI, JOSEPH RALPH (MD)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:RALPH
Last Name:BENOTTI
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 1:123 SUMMER ST
Mailing Address - Street 2:SUITE 660
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01608-1216
Mailing Address - Country:US
Mailing Address - Phone:508-363-6330
Mailing Address - Fax:508-363-7555
Practice Address - Street 1:123 SUMMER ST
Practice Address - Street 2:SUITE 660
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01608-1216
Practice Address - Country:US
Practice Address - Phone:508-363-6330
Practice Address - Fax:508-363-7555
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-16
Last Update Date:2010-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA40836207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA2070189Medicaid
300275OtherHARVARD PILGRIM HEALTH CA
45921OtherFALLON HEALTH PLAN
0022212OtherNEIGHBORHOOD HEALTH PLAN
040836OtherTUFTS HEALTH PLAN
25-00766OtherUNITED HEALTHCARE
37986OtherCIGNA HEALTHCARE
987754OtherNETWORK HEALTH
2294752OtherAETNA
CT003069318Medicaid
060059416OtherRR MC
MAN01821OtherBCBS OF MA
45921OtherFALLON HEALTH PLAN
25-00766OtherUNITED HEALTHCARE