Provider Demographics
NPI:1831062678
Name:IVONE, BENJAMIN MICHAEL (NP)
Entity type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:MICHAEL
Last Name:IVONE
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:41R GROVE ST
Mailing Address - Street 2:
Mailing Address - City:MERRIMAC
Mailing Address - State:MA
Mailing Address - Zip Code:01860-1807
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:41R GROVE ST
Practice Address - Street 2:
Practice Address - City:MERRIMAC
Practice Address - State:MA
Practice Address - Zip Code:01860-1807
Practice Address - Country:US
Practice Address - Phone:978-790-2458
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-09-26
Last Update Date:2025-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2319031207PE0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical Services