Provider Demographics
NPI:1205820560
Name:HARTER, BENEDICT THOMAS (MD)
Entity Type:Individual
Prefix:
First Name:BENEDICT
Middle Name:THOMAS
Last Name:HARTER
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 1:225 ABRAHAM FLEXNER WAY
Mailing Address - Street 2:STE 700
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40202-1846
Mailing Address - Country:US
Mailing Address - Phone:502-561-4263
Mailing Address - Fax:502-561-4221
Practice Address - Street 1:225 ABRAHAM FLEXNER WAY
Practice Address - Street 2:STE 700
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40202-1846
Practice Address - Country:US
Practice Address - Phone:502-561-4263
Practice Address - Fax:502-561-4221
Is Sole Proprietor?:No
Enumeration Date:2005-09-01
Last Update Date:2012-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY232362082S0105X
IN01051602A2082S0105X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2082S0105XAllopathic & Osteopathic PhysiciansPlastic SurgerySurgery of the Hand
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200233230AMedicaid
KY64232366Medicaid
KYD32297Medicare UPIN
KY64232366Medicaid
KY400000791Medicare PIN
KY1266413Medicare PIN
IN240006587Medicare PIN