MEDICARE: SABRINA ANN BENJAMIN MD

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	207R00000X	Internal Medicine Physician	MD00025146	WA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	107299	OTHER	WA	DEPT. L & I
3	MD00025146	OTHER	WA	WA LICENSE

General Provider Information

NPI Number	:	1447280334
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SABRINA ANN BENJAMIN MD

Provider Business Mailing Address
First Line	:	PO BOX 8339
Second Line	:
City	:	LACEY
State	:	WA
Zip	:	98509-8339
Country	:	US
Telephone Number	:	360-701-2554
Fax Number	:	360-438-1297

Provider Business Practice Location Address
First Line	:	1340 ALLEGHENY COURT SE
Second Line	:	SUITE 304
City	:	OLYMPIA
State	:	WA
Zip	:	98503
Country	:	US
Telephone Number	:	360-701-2554
Fax Number	:	360-438-1297

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/04/2006
Last Update Date	:	06/01/2011

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