Provider Demographics
NPI:1255332631
Name:BENES, GEORGE (MD)
Entity Type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:
Last Name:BENES
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 1:2600 GLASGOW AVE
Mailing Address - Street 2:SUITE 203
Mailing Address - City:NEWARK
Mailing Address - State:DE
Mailing Address - Zip Code:19702-4777
Mailing Address - Country:US
Mailing Address - Phone:302-832-3755
Mailing Address - Fax:302-834-4863
Practice Address - Street 1:2600 GLASGOW AVE
Practice Address - Street 2:SUITE 203
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19702-4777
Practice Address - Country:US
Practice Address - Phone:302-832-3755
Practice Address - Fax:302-834-4863
Is Sole Proprietor?:No
Enumeration Date:2005-08-09
Last Update Date:2011-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC1-0002929174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
DEP00186634OtherRAILROAD MEDICARE ID NUM
DE4295809OtherAETNA PPO ID NUM
DE0000193901Medicaid
DE57005OtherAETNA-HMO ID NUM
DE0091433000OtherAMERIHEALTH
DE0091433000OtherPERSONAL CHOICE
DE0091433000OtherKEYSTONE
DEC48728OtherBLUE CROSS BLUE SHIELD
DE000000212085OtherUNISON HEALTH PLAN
DE00C010G14Medicare PIN