Provider Demographics
NPI:1790898757
Name:BENAVIDES, AURELIO (MD)
Entity Type:Individual
Prefix:DR
First Name:AURELIO
Middle Name:
Last Name:BENAVIDES
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 1:1004 SUSHRUTA DR
Mailing Address - Street 2:SUITE B
Mailing Address - City:MARTINSBURG
Mailing Address - State:WV
Mailing Address - Zip Code:25401-8898
Mailing Address - Country:US
Mailing Address - Phone:304-263-4949
Mailing Address - Fax:304-263-8725
Practice Address - Street 1:1004 SUSHRUTA DR
Practice Address - Street 2:SUITE B
Practice Address - City:MARTINSBURG
Practice Address - State:WV
Practice Address - Zip Code:25401-8898
Practice Address - Country:US
Practice Address - Phone:304-263-4949
Practice Address - Fax:304-263-8725
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WV10389208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0130592000Medicaid
WV0130592000Medicaid
D49229Medicare UPIN