Provider Demographics
NPI:1275691057
Name:BENSON, RICHARD T (MD,PHD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:T
Last Name:BENSON
Suffix:
Gender:M
Credentials:MD,PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 IRVING ST NW
Mailing Address - Street 2:EAST BUILDING, ROOM 6126
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20010-3017
Mailing Address - Country:US
Mailing Address - Phone:202-877-3154
Mailing Address - Fax:202-877-2166
Practice Address - Street 1:110 IRVING ST. NW
Practice Address - Street 2:EAST BUILDING, ROOM 6126
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20010
Practice Address - Country:US
Practice Address - Phone:202-877-3154
Practice Address - Fax:202-877-2166
Is Sole Proprietor?:No
Enumeration Date:2006-12-05
Last Update Date:2012-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY212082-12084N0400X
MDD00625992084N0400X
DCMD0352932084N0400X
VA01012431382084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYH15636Medicare UPIN