Healthcare Provider Details

I. General information

NPI: 1164405353
Provider Name (Legal Business Name): NATALIE IVANA BENE M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/22/2005
Last Update Date: 12/11/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 PINE GROVE CMNS
YORK PA
17403-5161
US

IV. Provider business mailing address

400 PINE GROVE CMNS
YORK PA
17403-5161
US

V. Phone/Fax

Practice location:
  • Phone: 717-755-4422
  • Fax: 717-755-2390
Mailing address:
  • Phone: 717-755-4422
  • Fax: 717-755-2390

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberMD423402
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code207ND0101X
TaxonomyMOHS-Micrographic Surgery Physician
License NumberMD423402
License Number StatePA
# 3
Primary TaxonomyN
Taxonomy Code207ND0900X
TaxonomyDermatopathology Physician
License NumberMD423402
License Number StatePA
# 4
Primary TaxonomyN
Taxonomy Code207NS0135X
TaxonomyProcedural Dermatology Physician
License NumberMD423402
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: