Healthcare Provider Details

I. General information

NPI: 1407970809
Provider Name (Legal Business Name): BENNER MEDICAL GROUP PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/19/2007
Last Update Date: 06/30/2026
Certification Date: 06/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14090 HG TRUEMAN RD STE 2300-710
SOLOMONS MD
20688-3151
US

IV. Provider business mailing address

14090 HG TRUEMAN RD STE 2300-710
SOLOMONS MD
20688-3151
US

V. Phone/Fax

Practice location:
  • Phone: 410-449-6602
  • Fax: 410-499-6605
Mailing address:
  • Phone: 410-449-6602
  • Fax: 410-499-6605

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: DR. CHARLES MYRON BENNER
Title or Position: PARTNER
Credential: MD
Phone: 410-499-6602