Provider Demographics
NPI:1518951557
Name:YU, BENSON W (MD)
Entity Type:Individual
Prefix:
First Name:BENSON
Middle Name:W
Last Name:YU
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 1:3601 CHAIN BRIDGE RD
Mailing Address - Street 2:UNIT D
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22030-3243
Mailing Address - Country:US
Mailing Address - Phone:703-691-1136
Mailing Address - Fax:703-691-8116
Practice Address - Street 1:3601 CHAIN BRIDGE RD
Practice Address - Street 2:UNIT D
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22030-3243
Practice Address - Country:US
Practice Address - Phone:703-691-1136
Practice Address - Fax:703-691-8116
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-06
Last Update Date:2015-05-07
Deactivation Date:2006-03-24
Deactivation Code:
Reactivation Date:2006-03-30
Provider Licenses
StateLicense IDTaxonomies
VA0101048810207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA5835984Medicaid
F43098Medicare UPIN
VA5835984Medicaid