Provider Demographics
NPI:1245520550
Name:DELUCIA, BENJAMIN CHARLES (MD)
Entity type:Individual
Prefix:DR
First Name:BENJAMIN
Middle Name:CHARLES
Last Name:DELUCIA
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:STONY BROOK UNIVERSITY MEDICAL CENTER
Mailing Address - Street 2:DEPARTMENT OF PSYCHIATRY HSC, T-10, ROOM 020
Mailing Address - City:STONY BROOK
Mailing Address - State:NY
Mailing Address - Zip Code:11794-8101
Mailing Address - Country:US
Mailing Address - Phone:631-444-3005
Mailing Address - Fax:631-444-7534
Practice Address - Street 1:STONY BROOK UNIVERSITY MEDICAL CENTER
Practice Address - Street 2:DEPARTMENT OF PSYCHIATRY HSC, T-10, ROOM 020
Practice Address - City:STONY BROOK
Practice Address - State:NY
Practice Address - Zip Code:11794-8101
Practice Address - Country:US
Practice Address - Phone:631-444-3005
Practice Address - Fax:631-444-7534
Is Sole Proprietor?:No
Enumeration Date:2011-04-08
Last Update Date:2015-06-15
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Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
390200000X
NY2788032084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program