Provider Demographics
NPI:1508825571
Name:HORTON, BENION S (MD)
Entity Type:Individual
Prefix:
First Name:BENION
Middle Name:S
Last Name:HORTON
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:PO BOX 601888
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-1888
Mailing Address - Country:US
Mailing Address - Phone:704-289-2553
Mailing Address - Fax:704-289-6496
Practice Address - Street 1:1550 FAUL STREET
Practice Address - Street 2:SUITE 2100
Practice Address - City:MONROE
Practice Address - State:NC
Practice Address - Zip Code:28112-5087
Practice Address - Country:US
Practice Address - Phone:704-289-2553
Practice Address - Fax:704-289-6496
Is Sole Proprietor?:No
Enumeration Date:2006-03-20
Last Update Date:2016-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2005-00203207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCNC1935Medicaid
NC2038456AOtherMEDICARE PTAN, INDIVIDUAL FOR WILKES
NC5900152Medicaid
NC1508825571Medicaid
NC5900153Medicaid
SCNC1935Medicaid
NC2345732Medicare PIN
NC5900153Medicaid