Provider Demographics
NPI:1437150521
Name:BENENSOHN, HOWARD S (MD)
Entity Type:Individual
Prefix:
First Name:HOWARD
Middle Name:S
Last Name:BENENSOHN
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 1:7204 MAPLE AVE
Mailing Address - Street 2:
Mailing Address - City:CHEVY CHASE
Mailing Address - State:MD
Mailing Address - Zip Code:20815-5110
Mailing Address - Country:US
Mailing Address - Phone:301-652-8362
Mailing Address - Fax:301-652-4568
Practice Address - Street 1:4545 CONNECTICUT AVE NW
Practice Address - Street 2:STE 306
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20008-6042
Practice Address - Country:US
Practice Address - Phone:202-244-5511
Practice Address - Fax:301-652-4568
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCMD47582084P0800X
MDD00085842084P0800X
CAG141952084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
BE175715Medicare ID - Type Unspecified
B94176Medicare UPIN