Healthcare Provider Details

I. General information

NPI: 1033351168
Provider Name (Legal Business Name): ANDREW ROBERT BENSON
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/06/2009
Last Update Date: 10/29/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 N WOLFE ST BLALOCK 1415
BALTIMORE MD
21287-0005
US

IV. Provider business mailing address

506 CREEK CROSSING LN
GLEN BURNIE MD
21060-7515
US

V. Phone/Fax

Practice location:
  • Phone: 410-955-8408
  • Fax:
Mailing address:
  • Phone: 410-935-8440
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberR162397
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberR162397
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: