Provider Demographics
NPI:1215031646
Name:BENSENHAVER, CHARLES BROOK III (MD)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:BROOK
Last Name:BENSENHAVER
Suffix:III
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 1:3430 NEWBURG RD STE 210
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40218-2458
Mailing Address - Country:US
Mailing Address - Phone:502-454-8800
Mailing Address - Fax:502-736-0140
Practice Address - Street 1:3430 NEWBURG RD STE 210
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40218-2458
Practice Address - Country:US
Practice Address - Phone:502-454-8800
Practice Address - Fax:502-736-0140
Is Sole Proprietor?:No
Enumeration Date:2006-09-07
Last Update Date:2019-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY25215174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64018716Medicaid
KYE34416Medicare UPIN
KY64018716Medicaid