Healthcare Provider Details

I. General information

NPI: 1316231624
Provider Name (Legal Business Name): ANDREA BENTON M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/03/2011
Last Update Date: 06/01/2022
Certification Date: 06/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2025 TECHNOLOGY PKWY STE 108
MECHANICSBURG PA
17050-9401
US

IV. Provider business mailing address

2025 TECHNOLOGY PKWY STE 108
MECHANICSBURG PA
17050-9401
US

V. Phone/Fax

Practice location:
  • Phone: 717-988-8170
  • Fax: 717-221-5398
Mailing address:
  • Phone: 717-988-8170
  • Fax: 717-221-5398

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberMT199888
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: