Basic Information
| Provider Information | |||||||||
| NPI: | 1760410252 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BENENSON | ||||||||
| FirstName: | RONALD | ||||||||
| MiddleName: | S. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1803 MOUNT ROSE AVE | ||||||||
| Address2: | STE B3 | ||||||||
| City: | YORK | ||||||||
| State: | PA | ||||||||
| PostalCode: | 174033026 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7178511405 | ||||||||
| FaxNumber: | 7178513469 | ||||||||
| Practice Location | |||||||||
| Address1: | 1001 S GEORGE ST | ||||||||
| Address2: | YORK HOSPITAL EMERGENCY DEPARTMENT | ||||||||
| City: | YORK | ||||||||
| State: | PA | ||||||||
| PostalCode: | 174033676 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7178512450 | ||||||||
| FaxNumber: | 7178513469 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/30/2006 | ||||||||
| LastUpdateDate: | 09/10/2012 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | MD021674E | PA | Y | Allopathic & Osteopathic Physicians | Emergency Medicine | 207R00000X | MD021674E | PA | N | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 34348 | 01 | PA | GEISINGER | OTHER | 30120296 | 01 | PA | AMERIHEALTH MERCY - CE | OTHER | 000877055 | 05 | PA | MEDICAID | 110090012 | 01 | PA | RAILROAD MEDICARE | OTHER | 1141123 | 01 | PA | AMERIHEALTH MERCY-YH | OTHER | 145106 | 01 | PA | HIGHMARK BLUE SHIELD | OTHER | 0068519000 | 01 | PA | AMERIHEALTH 65 PA | OTHER | 1537577 | 01 | PA | GATEWAY-YH | OTHER | 30120297 | 01 | PA | AMERIHEALTH MERCY - WRC | OTHER | 50067204 | 01 | PA | CAPITAL BLUE CROSS-YH | OTHER |