Provider Demographics
NPI:1376640946
Name:BENJAMIN, ROBERT (MD)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:
Last Name:BENJAMIN
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 1:12 MAYO PL
Mailing Address - Street 2:
Mailing Address - City:DRESHER
Mailing Address - State:PA
Mailing Address - Zip Code:19025-1228
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:12 MAYO PL
Practice Address - Street 2:
Practice Address - City:DRESHER
Practice Address - State:PA
Practice Address - Zip Code:19025-1228
Practice Address - Country:US
Practice Address - Phone:215-643-6425
Practice Address - Fax:215-643-6766
Is Sole Proprietor?:No
Enumeration Date:2006-09-17
Last Update Date:2007-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD 015283E2084P0800X
NJMA 621202084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA00 1536490 0005Medicaid
PAMD 015283EOtherMEDICAL LICENSE
NJMA 62120OtherMEDICAL LICENSE
PA00 1536490 0005Medicaid
NJMA 62120OtherMEDICAL LICENSE