Provider Demographics
NPI:1801066824
Name:BENJAMIN, MARY ELISABETH (MD)
Entity type:Individual
Prefix:DR
First Name:MARY
Middle Name:ELISABETH
Last Name:BENJAMIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:12162 TECH RD
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20904-1914
Mailing Address - Country:US
Mailing Address - Phone:301-681-6654
Mailing Address - Fax:301-681-2607
Practice Address - Street 1:12162 TECH RD
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20904-1914
Practice Address - Country:US
Practice Address - Phone:301-681-6654
Practice Address - Fax:301-681-2607
Is Sole Proprietor?:No
Enumeration Date:2008-03-05
Last Update Date:2023-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0048252207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD719005100Medicaid