Provider Demographics
NPI:1609554070
Name:BENNER, CHRISTIAN DAVID
Entity Type:Individual
Prefix:
First Name:CHRISTIAN
Middle Name:DAVID
Last Name:BENNER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7515 ROUTE 235
Mailing Address - Street 2:
Mailing Address - City:THOMPSONTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:17094-8738
Mailing Address - Country:US
Mailing Address - Phone:717-320-3298
Mailing Address - Fax:
Practice Address - Street 1:7515 ROUTE 235
Practice Address - Street 2:
Practice Address - City:THOMPSONTOWN
Practice Address - State:PA
Practice Address - Zip Code:17094-8738
Practice Address - Country:US
Practice Address - Phone:717-320-3298
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-06
Last Update Date:2023-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program