Provider Demographics
NPI:1699940320
Name:BENTON, ARNOLD JEROME (MD)
Entity type:Individual
Prefix:DR
First Name:ARNOLD
Middle Name:JEROME
Last Name:BENTON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:67 FANTON HILL RD
Mailing Address - Street 2:
Mailing Address - City:WESTON
Mailing Address - State:CT
Mailing Address - Zip Code:06883-2419
Mailing Address - Country:US
Mailing Address - Phone:203-226-4941
Mailing Address - Fax:
Practice Address - Street 1:67 FANTON HILL RD
Practice Address - Street 2:
Practice Address - City:WESTON
Practice Address - State:CT
Practice Address - Zip Code:06883-2419
Practice Address - Country:US
Practice Address - Phone:203-226-4941
Practice Address - Fax:203-226-2820
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-24
Last Update Date:2008-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0094402084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT009440OtherMEDICAL LICENSE