Provider Demographics
NPI:1992779144
Name:ENG, BENJAMIN PETER (MD)
Entity type:Individual
Prefix:DR
First Name:BENJAMIN
Middle Name:PETER
Last Name:ENG
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:PO BOX 936
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23501-0936
Mailing Address - Country:US
Mailing Address - Phone:757-446-5955
Mailing Address - Fax:757-446-5196
Practice Address - Street 1:721 FAIRFAX AVE
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23507-2007
Practice Address - Country:US
Practice Address - Phone:757-446-5955
Practice Address - Fax:757-446-5196
Is Sole Proprietor?:No
Enumeration Date:2006-02-15
Last Update Date:2009-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101032402207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA005612641Medicaid
NC05563OtherBC/BS
VA081922OtherANTHEM
VAPAROtherUSA MANAGED CARE
VA-002 -003OtherTRICARE/CHAMPUS
VAPAROtherAETNA
VA005624851Medicaid
VAPAROtherCORVEL/CORCARE
VA11092OtherSENTARA OPTIMA
VAPAROtherCIGNA
VA225564OtherUHC/MAMSI
NC8905563Medicaid
VAPAROtherVA HEALTH NETWORK
VAPAROtherFIRST HEALTH COMMERCIAL/SOUTHERN HEALTH/COVENTRY
VA2180428OtherUHC/MAMSI
VAPAROtherVIRGINIA PREMIER HEALTH
VAPAROtherMULTIPLAN
VAPAROtherFIRST HEALTH COMMERCIAL/SOUTHERN HEALTH/COVENTRY
NC8905563Medicaid
VA225564OtherUHC/MAMSI