Provider Demographics
NPI:1386622603
Name:BENAVIDEZ, OSCAR (MD)
Entity type:Individual
Prefix:
First Name:OSCAR
Middle Name:
Last Name:BENAVIDEZ
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 1:91 SHAW RD
Mailing Address - Street 2:
Mailing Address - City:CHESTNUT HILL
Mailing Address - State:MA
Mailing Address - Zip Code:02467-3121
Mailing Address - Country:US
Mailing Address - Phone:617-869-9729
Mailing Address - Fax:
Practice Address - Street 1:175 CAMBRIDGE ST STE 510
Practice Address - Street 2:MASSACHUSETTS GENERAL HOSPITAL
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02114-2794
Practice Address - Country:US
Practice Address - Phone:617-726-3824
Practice Address - Fax:617-643-9643
Is Sole Proprietor?:No
Enumeration Date:2006-01-06
Last Update Date:2013-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA218780208000000X, 2080P0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0202XAllopathic & Osteopathic PhysiciansPediatricsPediatric Cardiology
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAJ29185OtherHMO BLUE
MA0036825OtherNEIGHBORHOOD HEALTH PLAN
MAJ29185OtherBLUE CARE ELECT
MA494159OtherTUFTS HEALTH PLAN
MAAA41200OtherHARVARD PILGRIM
MAJ29185OtherBCBS MA
MA96618601OtherNETWORK HEALTH
NY02712614Medicaid
CT2113643Medicaid
CT2113643Medicaid
MAJ29185OtherHMO BLUE