Provider Demographics
NPI:1235422858
Name:EJINDU, BENSON IKENNA
Entity Type:Individual
Prefix:MR
First Name:BENSON
Middle Name:IKENNA
Last Name:EJINDU
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4430 OAKBURN DR
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28269-1695
Mailing Address - Country:US
Mailing Address - Phone:704-906-2470
Mailing Address - Fax:704-733-9771
Practice Address - Street 1:8305 UNIVERSITY EXEC PARK DR
Practice Address - Street 2:SUITE 340
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28262-1361
Practice Address - Country:US
Practice Address - Phone:704-733-9771
Practice Address - Fax:704-733-9771
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-17
Last Update Date:2011-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor