Provider Demographics
NPI:1922159326
Name:SMITH, BENJAMIN R (MD)
Entity Type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:R
Last Name:SMITH
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 1:14 RESEARCH PL
Mailing Address - Street 2:
Mailing Address - City:N CHELMSFORD
Mailing Address - State:MA
Mailing Address - Zip Code:01863-2412
Mailing Address - Country:US
Mailing Address - Phone:978-256-6607
Mailing Address - Fax:978-250-8189
Practice Address - Street 1:14 RESEARCH PL
Practice Address - Street 2:
Practice Address - City:N CHELMSFORD
Practice Address - State:MA
Practice Address - Zip Code:01863-2412
Practice Address - Country:US
Practice Address - Phone:978-256-6607
Practice Address - Fax:978-250-8189
Is Sole Proprietor?:No
Enumeration Date:2007-01-15
Last Update Date:2019-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA213442207RC0000X, 207RC0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0001XAllopathic & Osteopathic PhysiciansInternal MedicineClinical Cardiac Electrophysiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0190110Medicaid
MAA33994Medicare ID - Type Unspecified
MA0190110Medicaid