Healthcare Provider Details

I. General information

NPI: 1730679846
Provider Name (Legal Business Name): BESHOY BENYAMEN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: BESHOY BENYAMEN MD

II. Dates (important events)

Enumeration Date: 05/14/2018
Last Update Date: 06/25/2024
Certification Date: 06/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 E HOSPITAL ST STE 3
MANNING SC
29102-3149
US

IV. Provider business mailing address

50 E HOSPITAL ST STE 3
MANNING SC
29102-3149
US

V. Phone/Fax

Practice location:
  • Phone: 803-435-8828
  • Fax: 803-435-2239
Mailing address:
  • Phone: 803-435-8828
  • Fax: 803-435-2239

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberLL92095
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: