MEDICARE: PHILIP J. BENYO, M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363AM0700X	Medical Physician Assistant	MA051116	PA
2	207RG0300X	Geriatric Medicine (Internal Medicine) Physician	MD022634E	PA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	104101VRM	OTHER	PA	MEDICARE PHYSICIAN ASST.
2	104097	OTHER	PA	MEDICARE GROUP #
3	400852VRM	OTHER	PA	MEDICARE DR.'S INDIVIDUAL

General Provider Information

NPI Number	:	1235235201
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PHILIP J. BENYO, M.D.

Provider Business Mailing Address
First Line	:	144 S OLD TURNPIKE RD
Second Line	:	PO BOX 395
City	:	DRUMS
State	:	PA
Zip	:	18222-1720
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	144 S OLD TURNPIKE RD
Second Line	:
City	:	DRUMS
State	:	PA
Zip	:	18222-1720
Country	:	US
Telephone Number	:	570-788-6363
Fax Number	:

Authorized Official
Title or Position	:	PHYSICIAN
Name	:	PHILIP J. BENYO
Credential	:	M.D.
Telephone Number	:	570-788-6363

Provider Enumeration Date	:	09/16/2006
Last Update Date	:	07/27/2007

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