Provider Demographics
NPI:1538132709
Name:TARANTINO, BENEDETTO (MD)
Entity type:Individual
Prefix:DR
First Name:BENEDETTO
Middle Name:
Last Name:TARANTINO
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 1:370 E RIDGE RD
Mailing Address - Street 2:SUITE 400
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14621-1240
Mailing Address - Country:US
Mailing Address - Phone:585-922-0600
Mailing Address - Fax:
Practice Address - Street 1:370 E RIDGE RD
Practice Address - Street 2:SUITE 400
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14621-1240
Practice Address - Country:US
Practice Address - Phone:585-922-0600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-08
Last Update Date:2009-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY141815207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00682251Medicaid
NYP00280777OtherRAILROAD MEDICARE
NY00682251Medicaid
NYU70005Medicare PIN