Provider Demographics
NPI:1487829859
Name:BENNIN, CHARLES-LWANGA KOBINA (MD)
Entity Type:Individual
Prefix:DR
First Name:CHARLES-LWANGA
Middle Name:KOBINA
Last Name:BENNIN
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 1:3656 CAPE CENTER DR
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28304-4406
Mailing Address - Country:US
Mailing Address - Phone:910-221-0300
Mailing Address - Fax:910-321-1022
Practice Address - Street 1:3656 CAPE CENTER DR
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28304-4406
Practice Address - Country:US
Practice Address - Phone:910-221-0300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-04-28
Last Update Date:2015-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD441961207R00000X
390200000X
FLTRN17421207RC0000X
NC2015-00944207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program