Provider Demographics
NPI:1932383775
Name:BENSON, STEPHANIE MICHELLE (MD)
Entity Type:Individual
Prefix:DR
First Name:STEPHANIE
Middle Name:MICHELLE
Last Name:BENSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6040 UNIVERSITY TOWN CENTRE DR
Mailing Address - Street 2:
Mailing Address - City:MORGANTOWN
Mailing Address - State:WV
Mailing Address - Zip Code:26501-2421
Mailing Address - Country:US
Mailing Address - Phone:304-598-4000
Mailing Address - Fax:304-285-7373
Practice Address - Street 1:6040 UNIVERSITY TOWN CENTRE DR
Practice Address - Street 2:
Practice Address - City:MORGANTOWN
Practice Address - State:WV
Practice Address - Zip Code:26501-2421
Practice Address - Country:US
Practice Address - Phone:304-285-1733
Practice Address - Fax:304-285-7373
Is Sole Proprietor?:No
Enumeration Date:2007-12-27
Last Update Date:2022-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMMD2007-0508207Q00000X
WV22450207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine