Provider Demographics
NPI:1134200520
Name:BENEDICT, KARL TEMPLE II (MD)
Entity type:Individual
Prefix:
First Name:KARL
Middle Name:TEMPLE
Last Name:BENEDICT
Suffix:II
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 1:80 DEAN RD
Mailing Address - Street 2:
Mailing Address - City:WESTON
Mailing Address - State:MA
Mailing Address - Zip Code:02493-2711
Mailing Address - Country:US
Mailing Address - Phone:781-235-4897
Mailing Address - Fax:
Practice Address - Street 1:80 DEAN RD
Practice Address - Street 2:
Practice Address - City:WESTON
Practice Address - State:MA
Practice Address - Zip Code:02493-2711
Practice Address - Country:US
Practice Address - Phone:781-235-4897
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-18
Last Update Date:2009-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA304682085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0105988Medicaid
MAM07874Medicare ID - Type Unspecified
MA0105988Medicaid
B75681Medicare UPIN