Jonathan A Benjamin, MD
Individual provider Active NPI Pediatrics Physician · Newton Centre, MA
NPI 1699734202 · NPPES record last updated Dec 5, 2008
Key facts
- NPI
- 1699734202
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pediatrics Physician 208000000X
- License
- 47711 (MA)
- Practice address
- 1400 Centre St
Suite 203
Newton Centre, MA 02459-2454 - Phone
- (617) 244-9929
- Fax
- (617) 244-9935
- NPI assigned
- Mar 22, 2006
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 47711 | MA | MD | Pediatrics Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Newton Centre Kids, LLC | Pediatrics | Past | Accepting new patients |
Interoperability endpoints
- jbenjamin7739@direct.chppoc.masshiway.net
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | 47711 | MA | Yes |
Addresses
Primary practice location
1400 Centre St
Suite 203
Newton Centre, MA 02459-2454
Mailing address
1400 Centre St
Suite 203
Newton Centre, MA 02459-2454
Phone (617) 244-9929
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 3086470 | Medicaid | MA |
Other providers in Newton Centre, MA
- Baek Dental, P.C.
- Paul Woojong Baek
- Kathleen E. Barrett
- Barry J Goldberg DMD PC
- Barry J Goldberg DMD PC
- Anna Berik
- Gregory Keith Binus
- Herbert S Birnbaum
- Sibylle Bosslet
- Kimberly D Boyd
All providers in Newton Centre, MA · Pediatrics Physician in Massachusetts
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 5, 2008. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.