Healthcare Provider Details

I. General information

NPI: 1629295332
Provider Name (Legal Business Name): MARY E BENONIS M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MARY E TRIMBERGER M.D.

II. Dates (important events)

Enumeration Date: 04/20/2007
Last Update Date: 10/08/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2600 E 7TH ST SUITE 100
CHARLOTTE NC
28204-4375
US

IV. Provider business mailing address

PO BOX 60447
CHARLOTTE NC
28260-0447
US

V. Phone/Fax

Practice location:
  • Phone: 704-384-8800
  • Fax: 704-384-8819
Mailing address:
  • Phone: 704-384-8800
  • Fax: 704-384-8819

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number2008-00490
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: