1942246319 NPI number — PAMELA F BENSIMHON MD

Table of content: PAMELA F BENSIMHON MD (NPI 1942246319)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1942246319 NPI number — PAMELA F BENSIMHON MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BENSIMHON
Provider First Name:
PAMELA
Provider Middle Name:
F
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

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:
1942246319
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/23/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3912 HAZEL LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GREENSBORO
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27408-3188
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
336-638-6111
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1150 REVOLUTION MILL DR STE 11
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GREENSBORO
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27405-5086
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
336-763-2344
Provider Business Practice Location Address Fax Number:
336-790-9752
Provider Enumeration Date:
06/22/2006

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: 208000000X , with the licence number:  9901515 , 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: 10383978 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 3810007247 , issued by the state of ( WV ) . This identifiers is of the category "MEDICAID".
  • Identifier: 189347 . This is a "MEDCOST" identifier . This identifiers is of the category "OTHER".
  • Identifier: 7523810 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 142JX . This is a "BCBS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 808932 . This is a "PARTNERS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 5904844 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".




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