Provider Demographics
NPI:1609876630
Name:GASTROENTEROLOGY SPECIALISTS OF DELAWARE LLC
Entity Type:Organization
Organization Name:GASTROENTEROLOGY SPECIALISTS OF DELAWARE LLC
Other - Org Name:GEORGE BENES, MD
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER/PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:
Authorized Official - Last Name:BENES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:302-832-3755
Mailing Address - Street 1:2600 GLASGOW AVENUE
Mailing Address - Street 2:SUITE 106
Mailing Address - City:NEWARK
Mailing Address - State:DE
Mailing Address - Zip Code:19702-5704
Mailing Address - Country:US
Mailing Address - Phone:302-832-3755
Mailing Address - Fax:302-834-4863
Practice Address - Street 1:2600 GLASGOW AVENUE
Practice Address - Street 2:SUITE 106
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19702-5704
Practice Address - Country:US
Practice Address - Phone:302-832-3755
Practice Address - Fax:302-834-4863
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-01
Last Update Date:2014-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DE1992101864174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE0000323502Medicaid
DE2302564000OtherAMERIHEALTH
DE2302564000OtherKEYSTONE
DE000000212087OtherUNISON HEALTH PLAN
DE2302564000OtherPERSONAL CHOICE
DEDC7235OtherRAILROAD MEDICARE
DE0000323502Medicaid