Healthcare Provider Details

I. General information

NPI: 1932594553
Provider Name (Legal Business Name): CONNOR SAMUEL BENTON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/31/2015
Last Update Date: 09/04/2026
Certification Date: 09/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1635 N GEORGE MASON DR STE 490
ARLINGTON VA
22205-3671
US

IV. Provider business mailing address

1635 N GEORGE MASON DR STE 490
ARLINGTON VA
22205-3671
US

V. Phone/Fax

Practice location:
  • Phone: 703-522-5300
  • Fax: 703-908-0148
Mailing address:
  • Phone: 703-522-5300
  • Fax: 703-908-0148

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number0101263634
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: