MEDICARE: JOHN JOSEPH BENECK PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	PA-586	ME
2	363A00000X	Physician Assistant	0010-06453	NC

General Provider Information

NPI Number	:	1043251325
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOHN JOSEPH BENECK PA-C

Provider Business Mailing Address
First Line	:	1144 N ROAD ST STE 200
Second Line	:
City	:	ELIZABETH CITY
State	:	NC
Zip	:	27909-3473
Country	:	US
Telephone Number	:	252-384-2360
Fax Number	:	252-384-2359

Provider Business Practice Location Address
First Line	:	1144 N ROAD ST STE 200
Second Line	:
City	:	ELIZABETH CITY
State	:	NC
Zip	:	27909-3473
Country	:	US
Telephone Number	:	252-384-2360
Fax Number	:	252-384-2359

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/09/2006
Last Update Date	:	05/06/2024

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