Basic Information
| Provider Information | |||||||||
| NPI: | 1700919065 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BENZON | ||||||||
| FirstName: | MELISSA | ||||||||
| MiddleName: | T. | ||||||||
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| Credential: | RD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 785 5TH AVENUE | ||||||||
| Address2: | SUITE 3 | ||||||||
| City: | CHAMBERSBURG | ||||||||
| State: | PA | ||||||||
| PostalCode: | 172014232 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7172639555 | ||||||||
| FaxNumber: | 7172174217 | ||||||||
| Practice Location | |||||||||
| Address1: | 12 ST PAUL DR STE 210 | ||||||||
| Address2: | |||||||||
| City: | CHAMBERSBURG | ||||||||
| State: | PA | ||||||||
| PostalCode: | 172011035 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7172176820 | ||||||||
| FaxNumber: | 7172176942 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/14/2007 | ||||||||
| LastUpdateDate: | 08/03/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/03/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 133VN1006X | 922760 | PA | N | Dietary & Nutritional Service Providers | Dietitian, Registered | Nutrition, Metabolic | 133V00000X | DN003025 | PA | Y | Dietary & Nutritional Service Providers | Dietitian, Registered | 133NN1002X | DN003025 | PA | N | Dietary & Nutritional Service Providers | Nutritionist | Nutrition, Education |
ID Information
| ID | Type | State | Issuer | Description | 102530279 | 05 | PA | MEDICAID | 867633 | 01 | PA | MEDICARE GROUP # | OTHER | 1007307260041 | 01 | PA | MEDICAID GROUP # | OTHER | DN003025 | 01 | PA | LICENSE | OTHER |