Provider Demographics
NPI:1184622391
Name:BENYO, PHILIP J (MD)
Entity type:Individual
Prefix:
First Name:PHILIP
Middle Name:J
Last Name:BENYO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 783311
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19178-3311
Mailing Address - Country:US
Mailing Address - Phone:484-884-4500
Mailing Address - Fax:484-884-0699
Practice Address - Street 1:642 STATE ROUTE 93 HWY
Practice Address - Street 2:
Practice Address - City:SUGARLOAF
Practice Address - State:PA
Practice Address - Zip Code:18249-3127
Practice Address - Country:US
Practice Address - Phone:570-788-6363
Practice Address - Fax:570-788-7313
Is Sole Proprietor?:No
Enumeration Date:2005-07-12
Last Update Date:2025-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD022634E207R00000X, 207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA192731OtherBLACK LUNG & EEOICP
PA507382OtherAETNA-BLUE BELL
PA800325OtherAETNA- EL PASO
PA9204269OtherPHCS
PA400852OtherBC/BS
PA47875OtherHEALTHAMERICA/ASSURANCE
PA6003253OtherGHI
PAD00852OtherAMERIHEALTH
PA23259OtherGEISINGER
PA000985956-0009Medicaid
PA002840OtherFIRST PRIORITY
PAC33395Medicare UPIN