Provider Demographics
NPI:1922085885
Name:BENJAMIN, TRACY E (PA)
Entity Type:Individual
Prefix:MS
First Name:TRACY
Middle Name:E
Last Name:BENJAMIN
Suffix:
Gender:F
Credentials:PA
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Mailing Address - Street 1:40 HART ST
Mailing Address - Street 2:BUILDING A FLOOR 3
Mailing Address - City:NEW BRITAIN
Mailing Address - State:CT
Mailing Address - Zip Code:06052-1743
Mailing Address - Country:US
Mailing Address - Phone:860-225-1227
Mailing Address - Fax:860-225-1253
Practice Address - Street 1:YALE NEW HAVEN HOSPITAL
Practice Address - Street 2:1450 CHAPEL STREET
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06511
Practice Address - Country:US
Practice Address - Phone:203-789-3000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-30
Last Update Date:2019-04-04
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CT000704363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTS49388Medicare UPIN