Provider Demographics
NPI:1720253719
Name:BENEDITH, PETER CHUKWUKA (MD)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:CHUKWUKA
Last Name:BENEDITH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:PETER
Other - Middle Name:
Other - Last Name:ENWEZANA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:580 CALIFORNIA STREET 12FLOOR
Mailing Address - Street 2:
Mailing Address - City:SF
Mailing Address - State:CA
Mailing Address - Zip Code:94104-1333
Mailing Address - Country:US
Mailing Address - Phone:510-424-1344
Mailing Address - Fax:510-281-0151
Practice Address - Street 1:580 CALIFORNIA STREET 12FLOOR
Practice Address - Street 2:
Practice Address - City:SF
Practice Address - State:CA
Practice Address - Zip Code:94104-1333
Practice Address - Country:US
Practice Address - Phone:510-424-1344
Practice Address - Fax:510-281-0151
Is Sole Proprietor?:No
Enumeration Date:2008-04-29
Last Update Date:2023-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY266515207R00000X
CA140700207R00000X
NYNY266515207R00000X
CACA140700207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0104161Medicaid
OH0104161Medicaid