Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VX0201X | Gynecologic Oncologist | 017010 | GA |
NPI | 1205802733 |
---|---|
Provider Name | Dr. Benedict B Benigno |
First Address | Atlanta, GA 30342-1626 |
Second Address | Atlanta, GA 30342-1626 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/02/2006 |
Last Update Date | 11/01/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000007246F | (05) | GA |
D44841 | (02) |