Provider Demographics
NPI:1255408498
Name:BENESKY, WILLIAM THOMAS JR (PA-C)
Entity type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:THOMAS
Last Name:BENESKY
Suffix:JR
Gender:M
Credentials:PA-C
Other - Prefix:MR
Other - First Name:WILLIAM
Other - Middle Name:THOMAS
Other - Last Name:BENESKY
Other - Suffix:JR
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:2920 HIGHWOODS BLVD
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27604-0010
Mailing Address - Country:US
Mailing Address - Phone:877-498-4490
Mailing Address - Fax:
Practice Address - Street 1:3009 NEW BERN AVE
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27610-1214
Practice Address - Country:US
Practice Address - Phone:919-232-5020
Practice Address - Fax:919-232-5021
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-30
Last Update Date:2021-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0010-02515363A00000X, 363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1255408498Medicaid