Provider Demographics
NPI:1912966144
Name:BENZA, ROBERT (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:
Last Name:BENZA
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 1:5535 FAIR LN
Mailing Address - Street 2:SUITE C
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45227-3434
Mailing Address - Country:US
Mailing Address - Phone:513-221-5274
Mailing Address - Fax:513-961-5100
Practice Address - Street 1:7850 CAMARGO RD
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45243-2652
Practice Address - Country:US
Practice Address - Phone:513-561-5655
Practice Address - Fax:513-561-2319
Is Sole Proprietor?:No
Enumeration Date:2006-03-17
Last Update Date:2013-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-061822207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH180031748OtherRAILROAD MEDICARE
OH0970669Medicaid
OH0763177Medicare PIN
OH0763179Medicare PIN
OH0970669Medicaid
OH0763173Medicare PIN
OH0763178Medicare PIN
OHF81771Medicare UPIN
OH0763175Medicare PIN