Provider Demographics
NPI:1962443242
Name:BENSON, TERRY L (MD)
Entity type:Individual
Prefix:DR
First Name:TERRY
Middle Name:L
Last Name:BENSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:PO BOX 60447
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-0447
Mailing Address - Country:US
Mailing Address - Phone:704-316-6565
Mailing Address - Fax:704-316-6560
Practice Address - Street 1:6324 FAIRVIEW RD
Practice Address - Street 2:SUITE 310
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28210-3271
Practice Address - Country:US
Practice Address - Phone:704-316-6565
Practice Address - Fax:704-316-6560
Is Sole Proprietor?:No
Enumeration Date:2006-06-09
Last Update Date:2013-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC000030126207Q00000X, 207QG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8914992Medicaid
SCN30126Medicaid
NC8914992Medicaid
NC204754JMedicare UPIN