Provider Demographics
NPI:1891820148
Name:MICHAEL BIENENFELD MD PA
Entity Type:Organization
Organization Name:MICHAEL BIENENFELD MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:BIENENFELD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:919-303-1072
Mailing Address - Street 1:1505 SW CARY PKWY
Mailing Address - Street 2:SUITE 308
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27511-6219
Mailing Address - Country:US
Mailing Address - Phone:919-303-1072
Mailing Address - Fax:919-387-7552
Practice Address - Street 1:1505 SW CARY PKWY
Practice Address - Street 2:SUITE 308
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27511-6219
Practice Address - Country:US
Practice Address - Phone:919-303-1072
Practice Address - Fax:919-387-7552
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9600863207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1006HOtherBCBS OF NC
NC0402628OtherUNITED HEALTHCARE
NC891006HMedicaid
NCAETNAOther7812348
NC16833OtherPARTNERS NUMBER
NC2344643Medicare ID - Type UnspecifiedGROUP NUMBER
NC2232836AMedicare ID - Type UnspecifiedINDIVIDUAL NUMBER
NCE00521Medicare UPIN