Provider Demographics
NPI:1932339017
Name:BENDER, CARRIE LYNN ELIZABETH (DO)
Entity Type:Individual
Prefix:DR
First Name:CARRIE LYNN
Middle Name:ELIZABETH
Last Name:BENDER
Suffix:
Gender:F
Credentials:DO
Other - Prefix:DR
Other - First Name:CARRIE LYNN
Other - Middle Name:ELIZABETH
Other - Last Name:ECKENRODE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:1 W ELM ST
Mailing Address - Street 2:STE 100
Mailing Address - City:CONSHOHOCKEN
Mailing Address - State:PA
Mailing Address - Zip Code:19428-4108
Mailing Address - Country:US
Mailing Address - Phone:610-567-5387
Mailing Address - Fax:610-567-5420
Practice Address - Street 1:721 ARBOR WAY STE 105
Practice Address - Street 2:
Practice Address - City:BLUE BELL
Practice Address - State:PA
Practice Address - Zip Code:19422-1974
Practice Address - Country:US
Practice Address - Phone:215-646-9220
Practice Address - Fax:215-646-0715
Is Sole Proprietor?:No
Enumeration Date:2009-07-22
Last Update Date:2020-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS015692207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA231233Medicare PIN