Organization
BENNER MEDICAL GROUP PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. CHARLES MYRON BENNER MD (PARTNER)
(301) 866-0080
Entity
Organization
Contact information
Practice address
20945 GREAT MILLS RD, SUITE 203, LEXINGTON PARK, MD 20653-4369
(301) 866-0080
(301) 866-0010
Mailing address
PO BOX 62211, BALTIMORE, MD 21264
(301) 866-0080
(301) 866-0010
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
468851100
—
MD
Enumeration date
03/19/2007
Last updated
12/02/2008
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