Provider Demographics
NPI:1609868389
Name:BENSON, NICHOLAS H (MD)
Entity Type:Individual
Prefix:DR
First Name:NICHOLAS
Middle Name:H
Last Name:BENSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 751069
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28275-1069
Mailing Address - Country:US
Mailing Address - Phone:252-744-3520
Mailing Address - Fax:252-744-3194
Practice Address - Street 1:2100 STANTONSBURG RD
Practice Address - Street 2:ECU PHYSICIANS EMERGENCY MEDICINE AT PCMH
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27834-2818
Practice Address - Country:US
Practice Address - Phone:252-744-4757
Practice Address - Fax:252-744-4125
Is Sole Proprietor?:No
Enumeration Date:2005-08-18
Last Update Date:2011-10-26
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NC27120207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC930047261OtherRAILROAD MEDICARE
NC14980OtherBCBS NC
NC6914980Medicaid
NCC82790Medicare UPIN
NC204753Medicare PIN