Provider Demographics
NPI:1225759327
Name:BENESCH, MATTHEW GARY KENNETH (MD)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:GARY KENNETH
Last Name:BENESCH
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 1:279 NORTH STREET APT 242
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14201
Mailing Address - Country:US
Mailing Address - Phone:716-472-2001
Mailing Address - Fax:
Practice Address - Street 1:665 ELM STREET
Practice Address - Street 2:ATTN: SURGICAL ONCOLOGY 6TH FLOOR
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14203
Practice Address - Country:US
Practice Address - Phone:716-845-2300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-07
Last Update Date:2022-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program