Healthcare Provider Details

I. General information

NPI: 1558319145
Provider Name (Legal Business Name): BRUCE N BENGE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/05/2006
Last Update Date: 04/15/2025
Certification Date: 04/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2000 FOULK ROAD SUITE F
WILMINGTON DE
19810
US

IV. Provider business mailing address

2000 FOULK ROAD SUITE F
WILMINGTON DE
19810
US

V. Phone/Fax

Practice location:
  • Phone: 302-652-8990
  • Fax: 302-652-8646
Mailing address:
  • Phone: 302-652-8990
  • Fax: 302-652-8646

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License NumberCI0004343
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: