Provider Demographics
NPI:1811065907
Name:CO, BENITO KONG LENG (MD)
Entity type:Individual
Prefix:DR
First Name:BENITO KONG LENG
Middle Name:
Last Name:CO
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 1:18 LORD MAYORS COURT
Mailing Address - Street 2:
Mailing Address - City:COCKEYSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21030-2919
Mailing Address - Country:US
Mailing Address - Phone:410-667-6622
Mailing Address - Fax:
Practice Address - Street 1:18 LORD MAYORS COURT
Practice Address - Street 2:
Practice Address - City:COCKEYSVILLE
Practice Address - State:MD
Practice Address - Zip Code:21030-2919
Practice Address - Country:US
Practice Address - Phone:410-667-6622
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD14702208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
D70345Medicare UPIN
MD2311Medicare ID - Type Unspecified