Provider Demographics
NPI:1033125372
Name:BENJAMIN, MARSHALL E (MD)
Entity Type:Individual
Prefix:DR
First Name:MARSHALL
Middle Name:E
Last Name:BENJAMIN
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 1:300 HOSPITAL DR
Mailing Address - Street 2:STE 132
Mailing Address - City:GLEN BURNIE
Mailing Address - State:MD
Mailing Address - Zip Code:21061-6902
Mailing Address - Country:US
Mailing Address - Phone:410-787-4594
Mailing Address - Fax:410-553-8349
Practice Address - Street 1:301 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:GLEN BURNIE
Practice Address - State:MD
Practice Address - Zip Code:21061-5803
Practice Address - Country:US
Practice Address - Phone:410-553-8300
Practice Address - Fax:410-553-8349
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2016-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0050688208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE0000871201Medicaid
MD0016OtherCAREFIRST
MD65473OtherGEISINGER
MD013756100Medicaid
MD112716OtherUS HLTHCARE
MD1727681OtherUNITED HLTHCARE NATIONAL
MD340305OtherMDIPA
MD1700756OtherUNITED HLTHCARE
MD214349OtherKAISER
MD54350203OtherBLUE SHIELD
MD65473OtherGEISINGER
MDF94700Medicare UPIN
MD770001404Medicare ID - Type UnspecifiedRAILROAD