1922000678 NPI number — BENJAMIN D ESKRA M.D.

Table of content: BENJAMIN D ESKRA M.D. (NPI 1922000678)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1922000678 NPI number — BENJAMIN D ESKRA M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ESKRA
Provider First Name:
BENJAMIN
Provider Middle Name:
D
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1922000678
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/08/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 250
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BEAVER
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
15009-0250
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
800-634-0201
Provider Business Mailing Address Fax Number:
866-727-0896

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2400 WAYNE MEMORIAL DR
Provider Second Line Business Practice Location Address:
SUITE B
Provider Business Practice Location Address City Name:
GOLDSBORO
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27534-1789
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
919-587-4400
Provider Business Practice Location Address Fax Number:
919-587-4411
Provider Enumeration Date:
08/12/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 208200000X , with the licence number:  2009-00677 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 5913214 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".




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