Basic Information
| Provider Information | |||||||||
| NPI: | 1023438777 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BENYO | ||||||||
| FirstName: | DANIEL | ||||||||
| MiddleName: | EDWIN | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 783311 | ||||||||
| Address2: | |||||||||
| City: | PHILADELPHIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 191783311 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4848844500 | ||||||||
| FaxNumber: | 4848840699 | ||||||||
| Practice Location | |||||||||
| Address1: | 314 MAIN STREET | ||||||||
| Address2: | SUITE C | ||||||||
| City: | CONYNGHAM | ||||||||
| State: | PA | ||||||||
| PostalCode: | 182190395 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5707881108 | ||||||||
| FaxNumber: | 5707882499 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/21/2014 | ||||||||
| LastUpdateDate: | 02/13/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 02/13/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | MD460150 | PA | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 103322806-0003 | 05 | PA | MEDICAID |