Provider Demographics
NPI:1962588566
Name:BENZ UROLOGY PA
Entity type:Organization
Organization Name:BENZ UROLOGY PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:BARTLEY
Authorized Official - Last Name:BENZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:302-628-4222
Mailing Address - Street 1:9096 RIVERSIDE DR
Mailing Address - Street 2:
Mailing Address - City:SEAFORD
Mailing Address - State:DE
Mailing Address - Zip Code:19973-3658
Mailing Address - Country:US
Mailing Address - Phone:302-628-4222
Mailing Address - Fax:302-628-4225
Practice Address - Street 1:9096 RIVERSIDE DR
Practice Address - Street 2:
Practice Address - City:SEAFORD
Practice Address - State:DE
Practice Address - Zip Code:19973-3658
Practice Address - Country:US
Practice Address - Phone:302-628-4222
Practice Address - Fax:302-628-4225
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-27
Last Update Date:2011-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC1-00067392088P0231X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2088P0231XAllopathic & Osteopathic PhysiciansUrologyPediatric UrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE1000016049Medicaid
DE1000016049Medicaid