Provider Demographics
NPI:1972506103
Name:BENSON, RICHARD DAVID (MD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:DAVID
Last Name:BENSON
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 1:400 SHADOWLINE DR
Mailing Address - Street 2:SUITE 101
Mailing Address - City:BOONE
Mailing Address - State:NC
Mailing Address - Zip Code:28607-5089
Mailing Address - Country:US
Mailing Address - Phone:828-263-8707
Mailing Address - Fax:828-263-8710
Practice Address - Street 1:400 SHADOWLINE DR
Practice Address - Street 2:SUITE 101
Practice Address - City:BOONE
Practice Address - State:NC
Practice Address - Zip Code:28607-5089
Practice Address - Country:US
Practice Address - Phone:828-263-8707
Practice Address - Fax:828-263-8710
Is Sole Proprietor?:No
Enumeration Date:2005-05-23
Last Update Date:2014-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC33941207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC124010Medicaid
SC6317Medicare ID - Type Unspecified
SCC606336317Medicare PIN
NC2161107AMedicare PIN
SC124010Medicaid