Provider Demographics
NPI:1639314065
Name:BENSON, MARTHA HOPE (PAC)
Entity Type:Individual
Prefix:MS
First Name:MARTHA
Middle Name:HOPE
Last Name:BENSON
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3501 SINCLAIR LN
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21213-2029
Mailing Address - Country:US
Mailing Address - Phone:410-558-4888
Mailing Address - Fax:410-327-1693
Practice Address - Street 1:4000 ANNAPOLIS RD
Practice Address - Street 2:SUITE 105
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21227-3600
Practice Address - Country:US
Practice Address - Phone:410-789-8399
Practice Address - Fax:410-355-1768
Is Sole Proprietor?:No
Enumeration Date:2008-12-15
Last Update Date:2008-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDC0000789363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD376751500Medicaid