Provider Demographics
NPI:1508886698
Name:BENTON, CAMMY RENAE (MD)
Entity Type:Individual
Prefix:
First Name:CAMMY
Middle Name:RENAE
Last Name:BENTON
Suffix:
Gender:F
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 890273
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28289-0273
Mailing Address - Country:US
Mailing Address - Phone:828-327-4745
Mailing Address - Fax:828-322-3569
Practice Address - Street 1:1985 STARTOWN RD
Practice Address - Street 2:SUITE 102
Practice Address - City:HICKORY
Practice Address - State:NC
Practice Address - Zip Code:28602-8307
Practice Address - Country:US
Practice Address - Phone:828-327-4745
Practice Address - Fax:828-322-3569
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2015-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2003-01203207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC140JCOtherBCBS
NC140JCOtherBCBS
I19595Medicare UPIN
NC2044882AMedicare PIN
NC5901970Medicaid
NC2044882BMedicare PIN