Provider Demographics
NPI:1093009425
Name:BENSON, MAX (MD)
Entity Type:Individual
Prefix:DR
First Name:MAX
Middle Name:
Last Name:BENSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:PEYMAN
Other - Middle Name:
Other - Last Name:FARZANFAR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:506 6TH ST
Mailing Address - Street 2:EAST PAVILLION 3
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11215-3609
Mailing Address - Country:US
Mailing Address - Phone:718-780-5246
Mailing Address - Fax:718-780-3259
Practice Address - Street 1:1505 NORTHSIDE FORSYTH DR
Practice Address - Street 2:STE 3600
Practice Address - City:CUMMING
Practice Address - State:GA
Practice Address - Zip Code:30041
Practice Address - Country:US
Practice Address - Phone:770-343-8565
Practice Address - Fax:770-781-3559
Is Sole Proprietor?:No
Enumeration Date:2011-06-02
Last Update Date:2021-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA09516000207R00000X
NY276976207R00000X
GA83922207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine