Provider Demographics
NPI:1528021631
Name:BIENENFELD, MAURICE (MD)
Entity Type:Individual
Prefix:DR
First Name:MAURICE
Middle Name:
Last Name:BIENENFELD
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 1:1505 SW CARY PKWY
Mailing Address - Street 2:SUITE 308
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27511-6219
Mailing Address - Country:US
Mailing Address - Phone:919-303-1072
Mailing Address - Fax:919-303-1072
Practice Address - Street 1:1505 SW CARY PKWY
Practice Address - Street 2:SUITE 308
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27511-6219
Practice Address - Country:US
Practice Address - Phone:919-303-1072
Practice Address - Fax:919-303-1072
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-10
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9600863207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC891006HMedicaid
16833OtherPARTNERS INSURANCE
0402628OtherUHC/UHC MEDICARE
7812348OtherAETNA
NC1006HOtherBCBS OF NC
7812348OtherAETNA
NC891006HMedicaid