Provider Demographics
NPI:1629069968
Name:BENJERS, NELSON V (MD)
Entity Type:Individual
Prefix:
First Name:NELSON
Middle Name:V
Last Name:BENJERS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9131 PISCATAWAY RD
Mailing Address - Street 2:SUITE 600
Mailing Address - City:CLINTON
Mailing Address - State:MD
Mailing Address - Zip Code:20735-2508
Mailing Address - Country:US
Mailing Address - Phone:301-868-0110
Mailing Address - Fax:301-856-0604
Practice Address - Street 1:9131 PISCATAWAY RD
Practice Address - Street 2:SUITE 600
Practice Address - City:CLINTON
Practice Address - State:MD
Practice Address - Zip Code:20735-2508
Practice Address - Country:US
Practice Address - Phone:301-868-0110
Practice Address - Fax:301-856-0604
Is Sole Proprietor?:No
Enumeration Date:2005-11-04
Last Update Date:2008-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD00028281174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD1734OtherBC/BS MD
DC3104-0001OtherBC/BS DC
MD37590-1600Medicaid
MD000L48S66Medicare ID - Type UnspecifiedINDIVIDUAL MEDICARE #
MD110229199Medicare PIN
MD906EMedicare PIN
MD1734OtherBC/BS MD
MDB70358Medicare UPIN
MD37590-1600Medicaid