Provider Demographics
NPI:1336146968
Name:LARACUENTE, BENJAMIN ALBERTO (MD)
Entity Type:Individual
Prefix:DR
First Name:BENJAMIN
Middle Name:ALBERTO
Last Name:LARACUENTE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3468 BRODHEAD RD STE 11
Mailing Address - Street 2:
Mailing Address - City:MONACA
Mailing Address - State:PA
Mailing Address - Zip Code:15061-3149
Mailing Address - Country:US
Mailing Address - Phone:724-728-5995
Mailing Address - Fax:724-728-6705
Practice Address - Street 1:3468 BRODHEAD RD STE 11
Practice Address - Street 2:
Practice Address - City:MONACA
Practice Address - State:PA
Practice Address - Zip Code:15061-3149
Practice Address - Country:US
Practice Address - Phone:724-728-5995
Practice Address - Fax:724-728-6705
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-28
Last Update Date:2022-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD423382207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
P00101085OtherRR MEDICARE
PA1010604450001Medicaid
OH2285512Medicaid
OH2285512Medicaid
OH4065514Medicare PIN
PA076813LLFMedicare PIN