Provider Demographics
NPI:1194920025
Name:BENGE, JOSHUA M (MD)
Entity type:Individual
Prefix:
First Name:JOSHUA
Middle Name:M
Last Name:BENGE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 635283
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45263-5283
Mailing Address - Country:US
Mailing Address - Phone:859-635-9440
Mailing Address - Fax:859-448-2622
Practice Address - Street 1:2300 CHAMBER CENTER DR
Practice Address - Street 2:
Practice Address - City:LAKESIDE PARK
Practice Address - State:KY
Practice Address - Zip Code:41017-1686
Practice Address - Country:US
Practice Address - Phone:859-655-7040
Practice Address - Fax:859-331-2021
Is Sole Proprietor?:No
Enumeration Date:2007-06-20
Last Update Date:2024-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY41949207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH3080946Medicaid
KY7100101940Medicaid
KYP00739058OtherRAILROAD MEDICARE
KYP00847809OtherRAILROAD MEDICARE
OH3080946Medicaid
KY0387330Medicare PIN