Provider Demographics
NPI:1134295801
Name:BENWAY, EILEEN H (MD)
Entity Type:Individual
Prefix:DR
First Name:EILEEN
Middle Name:H
Last Name:BENWAY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:1844 SAN MIGUEL DR
Mailing Address - Street 2:SUITE 310
Mailing Address - City:WALNUT CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:94596-4962
Mailing Address - Country:US
Mailing Address - Phone:925-937-6000
Mailing Address - Fax:925-937-2823
Practice Address - Street 1:1844 SAN MIGUEL DR
Practice Address - Street 2:SUITE 310
Practice Address - City:WALNUT CREEK
Practice Address - State:CA
Practice Address - Zip Code:94596-4962
Practice Address - Country:US
Practice Address - Phone:925-937-6000
Practice Address - Fax:925-937-2823
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-27
Last Update Date:2011-09-26
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAA060503208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
G40154Medicare UPIN