Provider Demographics
NPI:1477552438
Name:TEGENE, BENYAM G (MD)
Entity Type:Individual
Prefix:DR
First Name:BENYAM
Middle Name:G
Last Name:TEGENE
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 1:503 N 21ST ST
Mailing Address - Street 2:
Mailing Address - City:CAMP HILL
Mailing Address - State:PA
Mailing Address - Zip Code:17011-2204
Mailing Address - Country:US
Mailing Address - Phone:717-763-2219
Mailing Address - Fax:717-972-4844
Practice Address - Street 1:503 NORTH 21ST ST.
Practice Address - Street 2:
Practice Address - City:CAMP HILL
Practice Address - State:PA
Practice Address - Zip Code:17011-8672
Practice Address - Country:US
Practice Address - Phone:717-763-2219
Practice Address - Fax:717-972-4844
Is Sole Proprietor?:No
Enumeration Date:2005-07-20
Last Update Date:2022-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD4190762084P0804X, 2084P0800X
PAMD419762084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA01924338Medicaid
PA063261Medicare ID - Type Unspecified
PA01924338Medicaid