Provider Demographics
NPI:1316598709
Name:BENJAMIN, LAWRENCE S (PA-C)
Entity type:Individual
Prefix:
First Name:LAWRENCE
Middle Name:S
Last Name:BENJAMIN
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:LAWRENCE
Other - Middle Name:TODD
Other - Last Name:SHERRER
Other - Suffix:JR
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:18 UNION ST
Mailing Address - Street 2:
Mailing Address - City:WEST SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01089-3317
Mailing Address - Country:US
Mailing Address - Phone:413-781-0100
Mailing Address - Fax:
Practice Address - Street 1:875 ENFIELD ST
Practice Address - Street 2:
Practice Address - City:ENFIELD
Practice Address - State:CT
Practice Address - Zip Code:06082-3617
Practice Address - Country:US
Practice Address - Phone:860-741-3014
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-26
Last Update Date:2021-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPA7274363A00000X
CT4605363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant