Provider Demographics
NPI:1699772491
Name:BENENATI, CAROLYN (MD)
Entity type:Individual
Prefix:
First Name:CAROLYN
Middle Name:
Last Name:BENENATI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:CAROLYN
Other - Middle Name:
Other - Last Name:HENDERSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:111 CHAMBERS HILL DR
Mailing Address - Street 2:STE 200
Mailing Address - City:CHAMBERSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17201-7304
Mailing Address - Country:US
Mailing Address - Phone:717-709-7922
Mailing Address - Fax:717-263-2055
Practice Address - Street 1:830 5TH AVE STE 202
Practice Address - Street 2:
Practice Address - City:CHAMBERSBURG
Practice Address - State:PA
Practice Address - Zip Code:17201-4224
Practice Address - Country:US
Practice Address - Phone:717-709-7990
Practice Address - Fax:717-709-7991
Is Sole Proprietor?:No
Enumeration Date:2005-07-07
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD424792207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA101098854Medicaid
H00397Medicare UPIN
PA080912KQCMedicare ID - Type Unspecified