=====================================================
General NPI Number Information
=====================================================
NPI Number | 1649276452
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | BENJAMIN DENNY KNOX MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/27/2005
-----------------------------------------------------
Last Update Date | 10/30/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 510 IDLEWILD AVE
-----------------------------------------------------
City | EASTON
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21601-3824
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 410-820-8226
-----------------------------------------------------
Fax | 410-820-8405
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 510 IDLEWILD AVE
-----------------------------------------------------
City | EASTON
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21601-3824
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 410-820-8226
-----------------------------------------------------
Fax | 410-820-8405
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 174400000X
-----------------------------------------------------
Taxonomy Name | Specialist
-----------------------------------------------------
License Number | D0043197
-----------------------------------------------------
License Number State | MD
-----------------------------------------------------