Provider Demographics
NPI:1710120555
Name:BENSON, MAGGIE
Entity Type:Individual
Prefix:
First Name:MAGGIE
Middle Name:
Last Name:BENSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 STATE ST STE 103A
Mailing Address - Street 2:SUITE 103A
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16507-1471
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:300 STATE ST STE 103A
Practice Address - Street 2:SUITE 103A
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16507-1471
Practice Address - Country:US
Practice Address - Phone:814-877-8540
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-04-09
Last Update Date:2021-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD445836207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA103009835Medicaid
PA424193Medicare PIN