1639314065 NPI number — MS. MARTHA HOPE BENSON PAC

Table of content: MS. MARTHA HOPE BENSON PAC (NPI 1639314065)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1639314065 NPI number — MS. MARTHA HOPE BENSON PAC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BENSON
Provider First Name:
MARTHA
Provider Middle Name:
HOPE
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
PAC
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:
1639314065
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/15/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3501 SINCLAIR LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BALTIMORE
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21213-2029
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
410-558-4888
Provider Business Mailing Address Fax Number:
410-327-1693

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4000 ANNAPOLIS RD
Provider Second Line Business Practice Location Address:
SUITE 105
Provider Business Practice Location Address City Name:
BALTIMORE
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21227-3600
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-789-8399
Provider Business Practice Location Address Fax Number:
410-355-1768
Provider Enumeration Date:
12/15/2008

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: 363A00000X , with the licence number:  C0000789 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 376751500 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com