Provider Demographics
NPI:1922030956
Name:BENSON, JON CARTER (PA-C)
Entity Type:Individual
Prefix:
First Name:JON
Middle Name:CARTER
Last Name:BENSON
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1063 HARDING MEMORIAL PKWY
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:OH
Mailing Address - Zip Code:43302-6365
Mailing Address - Country:US
Mailing Address - Phone:740-244-8550
Mailing Address - Fax:740-751-4584
Practice Address - Street 1:1063 HARDING MEMORIAL PKWY
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:OH
Practice Address - Zip Code:43302-6365
Practice Address - Country:US
Practice Address - Phone:740-244-8550
Practice Address - Fax:740-751-4584
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2021-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH50.000876207P00000X
OH50-00-0876363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHPA12058Medicare PIN
OHS62109Medicare UPIN