Basic Information
| Provider Information | |||||||||
| NPI: | 1184622391 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BENYO | ||||||||
| FirstName: | PHILIP | ||||||||
| MiddleName: | J. | ||||||||
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| Credential: | MD | ||||||||
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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: | 144 S OLD TURNPIKE RD | ||||||||
| Address2: | |||||||||
| City: | DRUMS | ||||||||
| State: | PA | ||||||||
| PostalCode: | 182221720 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5707886363 | ||||||||
| FaxNumber: | 5707887313 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/12/2005 | ||||||||
| LastUpdateDate: | 02/12/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 02/12/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RG0300X | MD022634E | PA | N | Allopathic & Osteopathic Physicians | Internal Medicine | Geriatric Medicine | 207R00000X | MD022634E | PA | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 9204269 | 01 | PA | PHCS | OTHER | 23259 | 01 | PA | GEISINGER | OTHER | 6003253 | 01 | PA | GHI | OTHER | D00852 | 01 | PA | AMERIHEALTH | OTHER | 000985956-0009 | 05 | PA | MEDICAID | 002840 | 01 | PA | FIRST PRIORITY | OTHER | 192731 | 01 | PA | BLACK LUNG & EEOICP | OTHER | 800325 | 01 | PA | AETNA- EL PASO | OTHER | 47875 | 01 | PA | HEALTHAMERICA/ASSURANCE | OTHER | 507382 | 01 | PA | AETNA-BLUE BELL | OTHER | 400852 | 01 | PA | BC/BS | OTHER |