Provider Demographics
NPI:1104083955
Name:KATHERINE S BENCZE MD PA
Entity type:Organization
Organization Name:KATHERINE S BENCZE MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KATHERINE
Authorized Official - Middle Name:S
Authorized Official - Last Name:BENCZE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:813-972-6354
Mailing Address - Street 1:PO BOX 272536
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33688-2536
Mailing Address - Country:US
Mailing Address - Phone:813-972-3654
Mailing Address - Fax:813-971-3960
Practice Address - Street 1:13601 BRUCE B DOWNS BLVD
Practice Address - Street 2:SUITE 261
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33613-4657
Practice Address - Country:US
Practice Address - Phone:813-972-3654
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-20
Last Update Date:2012-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME472412084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
D21501Medicare UPIN
FLBH307Medicare PIN