Provider Demographics
NPI:1992761472
Name:BENJAMIN, WAYNE DOUGLAS (MD)
Entity type:Individual
Prefix:DR
First Name:WAYNE
Middle Name:DOUGLAS
Last Name:BENJAMIN
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:6602 CHURCH HILL RD
Mailing Address - Street 2:200
Mailing Address - City:CHESTERTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21620
Mailing Address - Country:US
Mailing Address - Phone:410-778-0300
Mailing Address - Fax:410-778-0351
Practice Address - Street 1:6602 CHURCH HILL RD
Practice Address - Street 2:200
Practice Address - City:CHESTERTOWN
Practice Address - State:MD
Practice Address - Zip Code:21620
Practice Address - Country:US
Practice Address - Phone:410-778-0300
Practice Address - Fax:410-778-0351
Is Sole Proprietor?:No
Enumeration Date:2006-04-25
Last Update Date:2011-06-13
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MDD16488207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD033141400Medicaid
MD033141400Medicaid
D75245Medicare UPIN