Provider Demographics
NPI:1962533844
Name:A. BENAVIDES, M.D., INC.
Entity type:Organization
Organization Name:A. BENAVIDES, M.D., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:AURELIO
Authorized Official - Middle Name:
Authorized Official - Last Name:BENAVIDES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:304-263-4949
Mailing Address - Street 1:1004 SUSHRUTA DR
Mailing Address - Street 2:SUITE B
Mailing Address - City:MARTINSBURG
Mailing Address - State:WV
Mailing Address - Zip Code:25401-8898
Mailing Address - Country:US
Mailing Address - Phone:304-263-4949
Mailing Address - Fax:304-263-8725
Practice Address - Street 1:1004 SUSHRUTA DR
Practice Address - Street 2:SUITE B
Practice Address - City:MARTINSBURG
Practice Address - State:WV
Practice Address - Zip Code:25401-8898
Practice Address - Country:US
Practice Address - Phone:304-263-4949
Practice Address - Fax:304-263-8725
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV10389208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0130592000Medicaid
WVD49229Medicare UPIN
WV0130592000Medicaid