Provider Demographics
NPI:1659359420
Name:MENA, BENJAMIN NMN (MD)
Entity Type:Individual
Prefix:DR
First Name:BENJAMIN
Middle Name:NMN
Last Name:MENA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:2835 W DE LEON ST
Mailing Address - Street 2:SUITE 104
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33609-4130
Mailing Address - Country:US
Mailing Address - Phone:813-443-0606
Mailing Address - Fax:813-443-0608
Practice Address - Street 1:2835 W DE LEON ST
Practice Address - Street 2:SUITE 104
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33609-4130
Practice Address - Country:US
Practice Address - Phone:813-443-0606
Practice Address - Fax:813-443-0608
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-03
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME98740207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL78355OtherBLUE CROSS BLUE SHIELD ALL PLANS
FLAH232YOtherMEDICARE INDIVIDUAL PTAN
FL10919106OtherCAQH ID
FL7904315OtherAETNA
FL6116907OtherCIGNA
FL0421861OtherUNITED HEALTHCARE
FL0421861OtherUNITED HEALTHCARE
FL7904315OtherAETNA