Basic Information
| Provider Information | |||||||||
| NPI: | 1154395838 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BENOTTI | ||||||||
| FirstName: | PETER | ||||||||
| MiddleName: | N. | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 100 N ACADEMY AVE | ||||||||
| Address2: | |||||||||
| City: | DANVILLE | ||||||||
| State: | PA | ||||||||
| PostalCode: | 178224903 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5702716144 | ||||||||
| FaxNumber: | 5702716578 | ||||||||
| Practice Location | |||||||||
| Address1: | 100 N ACADEMY AVE | ||||||||
| Address2: | |||||||||
| City: | DANVILLE | ||||||||
| State: | PA | ||||||||
| PostalCode: | 178224903 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5702716439 | ||||||||
| FaxNumber: | 5702716852 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/17/2006 | ||||||||
| LastUpdateDate: | 07/16/2014 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208600000X | 25MA06316500 | NJ | Y | Allopathic & Osteopathic Physicians | Surgery |
ID Information
| ID | Type | State | Issuer | Description | 223431049 | 01 | HORIZON BCBS | OTHER | P4026641 | 01 | NJ | OXFORD HEALTH PLANS | OTHER | 100049953205 | 01 | UHC COMMUNITY & STATE AMERICHOICE | OTHER | 6173576 | 01 | AETNA HMO PCP | OTHER | 00000499532 | 01 | UHC COMMERCIAL & MEDICARE | OTHER | 0188611 | 05 | NJ | MEDICAID | 0854147000 | 01 | NJ | AMERIHEALTH | OTHER | 4208590 | 01 | AETNA PPO | OTHER | 0127120 | 01 | CIGNA | OTHER | 1154295838 | 01 | COVENTRY & FIRST HEALTH | OTHER | 60052498 | 01 | NJ | HORIZON NJ HEALTH | OTHER |