Provider Demographics
NPI:1306095542
Name:BENJAMIN, EDRIS (CNMT)
Entity type:Individual
Prefix:MS
First Name:EDRIS
Middle Name:
Last Name:BENJAMIN
Suffix:
Gender:F
Credentials:CNMT
Other - Prefix:MS
Other - First Name:EDRIS
Other - Middle Name:
Other - Last Name:BENJAMIN- CUMBERABTCH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CNMT
Mailing Address - Street 1:10 N GREENE ST
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21201-1524
Mailing Address - Country:US
Mailing Address - Phone:410-605-7000
Mailing Address - Fax:
Practice Address - Street 1:10 N GREENE ST
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21201-1524
Practice Address - Country:US
Practice Address - Phone:410-605-7000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-09-11
Last Update Date:2008-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDN00005362471N0900X
FL630692471N0900X
TX165192471N0900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2471N0900XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistNuclear Medicine Technology