Provider Demographics
NPI:1992896948
Name:BENOIT, NICOLAS R (DPM)
Entity type:Individual
Prefix:
First Name:NICOLAS
Middle Name:R
Last Name:BENOIT
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:44 S MAIN ST
Mailing Address - Street 2:P.O. BOX 2000
Mailing Address - City:RANDOLPH
Mailing Address - State:VT
Mailing Address - Zip Code:05060-1381
Mailing Address - Country:US
Mailing Address - Phone:802-728-7000
Mailing Address - Fax:802-728-2613
Practice Address - Street 1:44 S MAIN ST
Practice Address - Street 2:
Practice Address - City:RANDOLPH
Practice Address - State:VT
Practice Address - Zip Code:05060-1381
Practice Address - Country:US
Practice Address - Phone:802-728-7000
Practice Address - Fax:802-728-2613
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2010-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN006103213E00000X
VT056-0000180213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT0000171OtherMEDICARE
VT1013269Medicaid