Provider Demographics
NPI:1437100500
Name:BENAVAGE, MICHAEL F (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:F
Last Name:BENAVAGE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:1605 N CEDAR CREST BLVD
Mailing Address - Street 2:SUITE 110B
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18104-2351
Mailing Address - Country:US
Mailing Address - Phone:610-973-1410
Mailing Address - Fax:610-973-1449
Practice Address - Street 1:1400 MAIN ST
Practice Address - Street 2:
Practice Address - City:CATASAUQUA
Practice Address - State:PA
Practice Address - Zip Code:18032-2646
Practice Address - Country:US
Practice Address - Phone:610-264-0411
Practice Address - Fax:484-403-4016
Is Sole Proprietor?:No
Enumeration Date:2006-05-13
Last Update Date:2016-08-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAMD027619E207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA134561OtherHIGHMARK PA BLUE SHIELD
PA0017427920002Medicaid
PA080148024OtherPALMETTO RR
PA500001220OtherCAPITAL BLUE CROSS
PA080148024OtherPALMETTO RR
PA134561OtherHIGHMARK PA BLUE SHIELD
PA134561KZJMedicare PIN