Basic Information
| Provider Information | |||||||||
| NPI: | 1881036762 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BENHORMA | ||||||||
| FirstName: | REDA | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1327 | ||||||||
| Address2: | |||||||||
| City: | LACONIA | ||||||||
| State: | NH | ||||||||
| PostalCode: | 032471327 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6039342060 | ||||||||
| FaxNumber: | 6035277038 | ||||||||
| Practice Location | |||||||||
| Address1: | LAKES REGION GENERAL HOSPITAL | ||||||||
| Address2: | 80 HIGHLAND STREET | ||||||||
| City: | LACONIA | ||||||||
| State: | NH | ||||||||
| PostalCode: | 032463235 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6035277104 | ||||||||
| FaxNumber: | 6037376713 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/22/2013 | ||||||||
| LastUpdateDate: | 08/09/2018 | ||||||||
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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 | 207R00000X | MD.302401 | LA | N | Allopathic & Osteopathic Physicians | Internal Medicine | 208M00000X | MD.302401 | LA | N | Allopathic & Osteopathic Physicians | Hospitalist | 207R00000X | 18937 | NH | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 2426524 | 05 | LA | MEDICAID |