Healthcare Provider Details

I. General information

NPI: 1801296843
Provider Name (Legal Business Name): STEPHEN S. BENHAM,MDPC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/27/2014
Last Update Date: 08/27/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

41A DELAWARE AVE
SIDNEY NY
13838-1336
US

IV. Provider business mailing address

41A DELAWARE AVE
SIDNEY NY
13838-1336
US

V. Phone/Fax

Practice location:
  • Phone: 607-563-7477
  • Fax: 607-563-7479
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MS. MARGO L BENHAM
Title or Position: OFFICE MANAGER
Credential:
Phone: 607-563-7477