Provider Demographics
NPI:1720070436
Name:BENCIE, DAVID J (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:J
Last Name:BENCIE
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 1:620 7TH STREET
Mailing Address - Street 2:SUITE A
Mailing Address - City:WINDBER
Mailing Address - State:PA
Mailing Address - Zip Code:15963
Mailing Address - Country:US
Mailing Address - Phone:814-467-3400
Mailing Address - Fax:814-467-1025
Practice Address - Street 1:620 7TH STREET
Practice Address - Street 2:SUITE A
Practice Address - City:WINDBER
Practice Address - State:PA
Practice Address - Zip Code:15963
Practice Address - Country:US
Practice Address - Phone:814-467-3400
Practice Address - Fax:814-467-1025
Is Sole Proprietor?:No
Enumeration Date:2005-08-18
Last Update Date:2009-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD025803E207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0008988790001Medicaid
PA423943Medicare ID - Type Unspecified
PAC33868Medicare UPIN