Provider Demographics
NPI:1720085376
Name:BENJAMIN, BARRY J (MD)
Entity Type:Individual
Prefix:
First Name:BARRY
Middle Name:J
Last Name:BENJAMIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 LYONS ST
Mailing Address - Street 2:
Mailing Address - City:DEDHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02026-5599
Mailing Address - Country:US
Mailing Address - Phone:617-421-5984
Mailing Address - Fax:781-278-5667
Practice Address - Street 1:1 LYONS ST
Practice Address - Street 2:
Practice Address - City:DEDHAM
Practice Address - State:MA
Practice Address - Zip Code:02026-5599
Practice Address - Country:US
Practice Address - Phone:617-421-5984
Practice Address - Fax:781-278-5667
Is Sole Proprietor?:No
Enumeration Date:2005-06-28
Last Update Date:2021-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA35621207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
035621OtherTUFTS BENEFIT ADMIN
61094OtherHARVARD/PILGRIM
27399OtherCHILDREN'S MEDICAL SECURI
61094OtherHARVARD PILGRIM PPO
9627202OtherHEALTHSOURCE-MA
0016755OtherNEIGHBORHOOD HEALTH PLAN
61094OtherHARVARD PILGRIM POS
C07067OtherBS-BLUE CARE ELECT
C07067OtherBLUE SHIELD INDEMNITY
035621OtherTUFTS
035621OtherTUFTS SECURE HORIZONS
035621OtherTUFTS TOTAL HEALTH PLAN
C07067OtherHMO BLUE/BLUE CHOICE
2053136OtherMASS HEALTH
897246OtherFIRST SENIORITY
035621OtherTUFTS COMMONWELATH
040007325OtherRAILROAD MEDICARE
9627202OtherCIGNA HEALTH CARE
C07067OtherBLUE SHIELD INDEMNITY
C07067OtherBS-BLUE CARE ELECT