MEDICARE: CHARLES MYRON BENNER 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	207RG0300X	Geriatric Medicine (Internal Medicine) Physician	D0031563	MD
2	207R00000X	Internal Medicine Physician	D0031563	MD

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

General Provider Information

NPI Number	:	1902872435
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHARLES MYRON BENNER MD

Provider Business Mailing Address
First Line	:	14090 HG TRUEMAN RD STE 2300-710
Second Line	:
City	:	SOLOMONS
State	:	MD
Zip	:	20688-3151
Country	:	US
Telephone Number	:	410-449-6602
Fax Number	:	410-449-6605

Provider Business Practice Location Address
First Line	:	14090 HG TRUEMAN RD STE 2300-710
Second Line	:
City	:	SOLOMONS
State	:	MD
Zip	:	20688-3151
Country	:	US
Telephone Number	:	410-449-6602
Fax Number	:	410-449-6605

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

Provider Enumeration Date	:	02/24/2006
Last Update Date	:	11/30/2018

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Directions to “ CHARLES MYRON BENNER MD” Practice Location

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