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General NPI Number Information
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NPI Number | 1386233674
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Entity Type | Individual
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Provider Name | SAMUAL BENJAMIN RN, CNII
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Gender | Male
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Dates
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Enumeration Date | 01/12/2021
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Last Update Date | 01/12/2021
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Provider Practice Location Address
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Address Line | 22 S GREENE ST
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City | BALTIMORE
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State | MD
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Zip | 21201-1590
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Country | US
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Telephone | 410-328-8667
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Fax |
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Provider Business Mailing Address
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Address Line | 536 S ANN ST FL 2
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City | BALTIMORE
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State | MD
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Zip | 21231-2441
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Country | US
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Telephone | 302-983-8710
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163WP0808X
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Taxonomy Name | Psychiatric/Mental Health Registered Nurse
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License Number | L1-0054607
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License Number State | DE
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