Provider Demographics
NPI:1467709063
Name:PEGHEBE, BENJAMIN ROBERT
Entity Type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:ROBERT
Last Name:PEGHEBE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11340 EVANS TRL
Mailing Address - Street 2:#2T4
Mailing Address - City:BELTSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20705-3021
Mailing Address - Country:US
Mailing Address - Phone:443-682-3814
Mailing Address - Fax:
Practice Address - Street 1:11340 EVANS TRL
Practice Address - Street 2:#2T4
Practice Address - City:BELTSVILLE
Practice Address - State:MD
Practice Address - Zip Code:20705-3021
Practice Address - Country:US
Practice Address - Phone:443-682-3814
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-14
Last Update Date:2012-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide