Provider Demographics
NPI:1609194885
Name:BENAVIDES, DAVID ROGER (MD, PHD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:ROGER
Last Name:BENAVIDES
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Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:110 S PACA ST
Mailing Address - Street 2:3RD FLOOR
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21201-1642
Mailing Address - Country:US
Mailing Address - Phone:410-328-5605
Mailing Address - Fax:410-328-5425
Practice Address - Street 1:110 S PACA ST
Practice Address - Street 2:3RD FLOOR
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21201-1642
Practice Address - Country:US
Practice Address - Phone:410-328-5605
Practice Address - Fax:410-328-5425
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-12
Last Update Date:2017-04-07
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MDD775072084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology