Provider Demographics
NPI:1588690952
Name:TONNEAU, BENOIT ALBERT (MD)
Entity type:Individual
Prefix:DR
First Name:BENOIT
Middle Name:ALBERT
Last Name:TONNEAU
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:711 TROY SCHENECTADY RD STE 203
Mailing Address - Street 2:
Mailing Address - City:LATHAM
Mailing Address - State:NY
Mailing Address - Zip Code:12110-2461
Mailing Address - Country:US
Mailing Address - Phone:518-782-3700
Mailing Address - Fax:518-782-3799
Practice Address - Street 1:2546 BALLTOWN RD
Practice Address - Street 2:SUITE 200
Practice Address - City:SCHENECTADY
Practice Address - State:NY
Practice Address - Zip Code:12309-1079
Practice Address - Country:US
Practice Address - Phone:518-374-1444
Practice Address - Fax:518-374-0491
Is Sole Proprietor?:No
Enumeration Date:2006-06-25
Last Update Date:2018-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY214326207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY11411OtherMVP
NY7968646OtherAETNA
NY000492899001OtherBSNENY
NY200196OtherSENIOR WHOLE HELATH
NY02047634Medicaid
NY050323000046OtherFIDELIS
NY10031103OtherCDPHP
NY47364OtherGHI/HMO
NY59N841OtherEMPIRE BC
NY02047634Medicaid
NY47364OtherGHI/HMO