Healthcare Provider Details

I. General information

NPI: 1730565540
Provider Name (Legal Business Name): AKIL S BENJAMIN DO LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/04/2015
Last Update Date: 08/04/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

826 WASHINGTON RD SUITE 112
WESTMINSTER MD
21157-5750
US

IV. Provider business mailing address

12304 FOX MEADOW LN
W FRIENDSHIP MD
21794-9515
US

V. Phone/Fax

Practice location:
  • Phone: 443-693-7246
  • Fax: 866-605-3654
Mailing address:
  • Phone: 443-693-7246
  • Fax: 866-605-3654

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License NumberH0070446
License Number StateMD

VIII. Authorized Official

Name: AKIL S BENJAMIN
Title or Position: CEO
Credential: D.O.
Phone: 443-693-7246