Individual
SUSAN RENE BENSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
128 MEDICAL PARK RD, STE 200, MOORESVILLE, NC 28117-8578
(704) 696-2085
(704) 660-0194
Mailing address
650 SIGNAL HILL DRIVE EXT, PO BOX 1845, STATESVILLE, NC 28625-4353
(704) 696-2085
(704) 660-0194
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
200200492
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
89131JF
—
NC
Enumeration date
08/17/2005
Last updated
04/24/2017
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