Provider Demographics
NPI:1417191289
Name:BENSON, OLAJIDE OLADELE (MD)
Entity Type:Individual
Prefix:
First Name:OLAJIDE
Middle Name:OLADELE
Last Name:BENSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:OLAJIDE
Other - Middle Name:OLADELE
Other - Last Name:OLOGUNTOYE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:4849 N MESA ST STE 201
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79912-5919
Mailing Address - Country:US
Mailing Address - Phone:915-351-6600
Mailing Address - Fax:915-351-6601
Practice Address - Street 1:2270 JOE BATTLE BLVD STE Q
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79938-2610
Practice Address - Country:US
Practice Address - Phone:915-317-1500
Practice Address - Fax:915-201-5101
Is Sole Proprietor?:No
Enumeration Date:2009-04-23
Last Update Date:2019-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01074357A207RC0200X, 2084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000885493OtherBCBS BMG NEUROLOGY
IN20144680Medicaid
IN000000879694OtherBCBS MEMORIAL HOSPITALIST
IN000000879694OtherBCBS MEMORIAL HOSPITALIST
IN261970022Medicare PIN
INM100032727Medicare PIN