Basic Information
| Provider Information | |||||||||
| NPI: | 1689197360 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BENITO | ||||||||
| FirstName: | MARKO | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7305 BROOKSIDE DR | ||||||||
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| City: | FREDERICK | ||||||||
| State: | MD | ||||||||
| PostalCode: | 217023620 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2017056741 | ||||||||
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| Practice Location | |||||||||
| Address1: | 4494 N PALMER RD | ||||||||
| Address2: | |||||||||
| City: | BETHESDA | ||||||||
| State: | MD | ||||||||
| PostalCode: | 208890001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3012954000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/25/2017 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 367500000X | 26NJ00747300 | NJ | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered |
No ID Information.