| Benner Medical Group Pa | |
|
20945 Great Mills Rd Suite 203 Lexington Park MD 20653-4369 | |
| (301) 866-0080 | |
| (301) 866-0010 |
| Full Name | Benner Medical Group Pa |
|---|---|
| Speciality | Internal Medicine |
| Location | 20945 Great Mills Rd, Lexington Park, Maryland |
| Authorized Official Name and Position | Charles Myron Benner (PARTNER) |
| Authorized Official Contact | 3018660080 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Benner Medical Group Pa Po Box 62211 Baltimore MD 21264 Ph: (301) 866-0080 | Benner Medical Group Pa 20945 Great Mills Rd Suite 203 Lexington Park MD 20653-4369 Ph: (301) 866-0080 |
| NPI Number | 1407970809 |
|---|---|
| Provider Enumeration Date | 03/19/2007 |
| Last Update Date | 12/02/2008 |
| Medicare PECOS PAC ID | 9537186952 |
|---|---|
| Medicare Enrollment ID | O20081008000525 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1407970809 | NPI | - | NPPES |
| 468851100 | Medicaid | MD |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | (* (Not Available)) | Primary |
| Provider Name | Nichole L. Pelletier |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1841379781 PECOS PAC ID: 6608847561 Enrollment ID: I20040804000293 |
| Provider Name | Patricia A Gurny |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1235245820 PECOS PAC ID: 4688680325 Enrollment ID: I20060303000574 |
| Provider Name | Charles M Benner |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1902872435 PECOS PAC ID: 8820199615 Enrollment ID: I20081017000496 |
| Provider Name | Deborah S Foerter |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1831108422 PECOS PAC ID: 8123263589 Enrollment ID: I20130408000110 |
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