Provider Demographics
NPI:1316902703
Name:BENVENISTE, JOEL S (MD)
Entity type:Individual
Prefix:DR
First Name:JOEL
Middle Name:S
Last Name:BENVENISTE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3841 GREEN HILLS VILLAGE DR STE 200
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37215-2691
Mailing Address - Country:US
Mailing Address - Phone:615-322-3000
Mailing Address - Fax:
Practice Address - Street 1:3601 THE VANDERBILT CLINIC
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37232-0001
Practice Address - Country:US
Practice Address - Phone:615-322-3000
Practice Address - Fax:615-936-0605
Is Sole Proprietor?:No
Enumeration Date:2006-04-19
Last Update Date:2022-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN543772085R0202X
INO1057118A2085R0202X
IL036-0626842085R0202X
KY403012085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYP00928207OtherRR MEDICARE
IN200444860Medicaid
INP00044095Medicare ID - Type UnspecifiedRR
IN214160BMedicare ID - Type Unspecified
D62545Medicare UPIN
P400043654Medicare PIN
IN542650FFMedicare ID - Type Unspecified
IN200444860Medicaid
P400043652Medicare PIN
P400043653Medicare PIN