Basic Information
| Provider Information | |||||||||
| NPI: | 1356575864 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BENEDICT | ||||||||
| FirstName: | CAROL DEANE | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | MITNICK | ||||||||
| OtherFirstName: | CAROL DEANE | ||||||||
| OtherMiddleName: | BENEDICT | ||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | MD | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 3800 RESERVOID RD. NW SUITE 3004 | ||||||||
| Address2: | PHC 3RD FLOOR, DIV. OF RHEUM, GEORGETOWN UNIVERSITY HOS | ||||||||
| City: | WASHINGTON | ||||||||
| State: | DC | ||||||||
| PostalCode: | 22102 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2024446200 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 3800 RESERVOIR RD NW SUITE 3004 | ||||||||
| Address2: | PHC 3RD FLOOR, DIV. OF RHEUM, GEORGETOWN UNIVERSITY HOS | ||||||||
| City: | WASHINGTON | ||||||||
| State: | DC | ||||||||
| PostalCode: | 200072113 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2024446200 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/12/2009 | ||||||||
| LastUpdateDate: | 10/04/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| AuthorizedOfficialMiddleName: | |||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 207RR0500X | MD040698 | DC | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Rheumatology |
No ID Information.