Provider Demographics
NPI:1619938867
Name:BENJAMIN, EUGENE ELLIOT (MD)
Entity Type:Individual
Prefix:DR
First Name:EUGENE
Middle Name:ELLIOT
Last Name:BENJAMIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 60447
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-0447
Mailing Address - Country:US
Mailing Address - Phone:704-637-1779
Mailing Address - Fax:704-637-1121
Practice Address - Street 1:1910 JAKE ALEXANDER BLVD W STE 102
Practice Address - Street 2:
Practice Address - City:SALISBURY
Practice Address - State:NC
Practice Address - Zip Code:28147-1163
Practice Address - Country:US
Practice Address - Phone:704-637-1779
Practice Address - Fax:704-637-1121
Is Sole Proprietor?:No
Enumeration Date:2006-03-29
Last Update Date:2021-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD788212084N0400X
NC288422084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology