Provider Demographics
NPI:1154317618
Name:PINCHAM BENTON, ANDREA M (MD)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:M
Last Name:PINCHAM BENTON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ANDREA
Other - Middle Name:MICHELLE
Other - Last Name:PINCHAM BENTON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:3310 SHALLOWFORD CIRCLE
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35216-4486
Mailing Address - Country:US
Mailing Address - Phone:205-823-7285
Mailing Address - Fax:205-338-6481
Practice Address - Street 1:2805 DR JOHN HAYNES DR
Practice Address - Street 2:ST CLAIR REGIONAL HOSPITAL
Practice Address - City:PELL CITY
Practice Address - State:AL
Practice Address - Zip Code:35125
Practice Address - Country:US
Practice Address - Phone:205-338-3301
Practice Address - Fax:205-338-6481
Is Sole Proprietor?:No
Enumeration Date:2005-09-21
Last Update Date:2009-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL13834207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL5829126OtherAETNA
AL051521276Medicaid
AL051521276OtherBCBS
AL051521276OtherBCBS
AL5829126OtherAETNA
ALP00151148Medicare PIN