Provider Demographics
NPI:1942250048
Name:IANZITO, BENJAMIN M (MD)
Entity Type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:M
Last Name:IANZITO
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 1:27 PARK ST
Mailing Address - Street 2:CAPE COD HOSPITAL PSYCH CENTER
Mailing Address - City:HYANNIS
Mailing Address - State:MA
Mailing Address - Zip Code:02601
Mailing Address - Country:US
Mailing Address - Phone:508-862-5566
Mailing Address - Fax:508-775-1598
Practice Address - Street 1:27 PARK ST
Practice Address - Street 2:CAPE COD HOSPITAL PSYCH CENTER
Practice Address - City:HYANNIS
Practice Address - State:MA
Practice Address - Zip Code:02601
Practice Address - Country:US
Practice Address - Phone:508-862-5566
Practice Address - Fax:508-775-1598
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA364222084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
H05041Medicare ID - Type Unspecified
A55484Medicare UPIN