Provider Demographics
NPI:1891892626
Name:BENDER, DAVID BRIAN (MD)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:BRIAN
Last Name:BENDER
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:RR 3 BOX 298
Mailing Address - Street 2:
Mailing Address - City:GRAFTON
Mailing Address - State:WV
Mailing Address - Zip Code:26354-9553
Mailing Address - Country:US
Mailing Address - Phone:304-265-0409
Mailing Address - Fax:
Practice Address - Street 1:500 MARKET ST
Practice Address - Street 2:
Practice Address - City:GRAFTON
Practice Address - State:WV
Practice Address - Zip Code:26354-1184
Practice Address - Country:US
Practice Address - Phone:304-265-0400
Practice Address - Fax:304-265-6417
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV16234207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0043142000Medicaid
E99072Medicare UPIN
WV0043142000Medicaid