Provider Demographics
NPI:1972775039
Name:ROBERTS, BENJAMIN HALL (MD)
Entity Type:Individual
Prefix:DR
First Name:BENJAMIN
Middle Name:HALL
Last Name:ROBERTS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:400 COLUMBUS AVE
Mailing Address - Street 2:CREDENTIALING
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06519-1233
Mailing Address - Country:US
Mailing Address - Phone:203-503-3000
Mailing Address - Fax:203-503-3224
Practice Address - Street 1:226 DIXWELL AVE
Practice Address - Street 2:PEDIATRICS
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06511-3456
Practice Address - Country:US
Practice Address - Phone:203-503-3420
Practice Address - Fax:203-503-3422
Is Sole Proprietor?:No
Enumeration Date:2008-03-29
Last Update Date:2021-07-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA064258208000000X
GA002538208000000X
CT687716208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics