Basic Information
| Provider Information | |||||||||
| NPI: | 1922000678 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ESKRA | ||||||||
| FirstName: | BENJAMIN | ||||||||
| MiddleName: | D | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 250 | ||||||||
| Address2: | |||||||||
| City: | BEAVER | ||||||||
| State: | PA | ||||||||
| PostalCode: | 150090250 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8006340201 | ||||||||
| FaxNumber: | 8667270896 | ||||||||
| Practice Location | |||||||||
| Address1: | 2400 WAYNE MEMORIAL DR | ||||||||
| Address2: | SUITE B | ||||||||
| City: | GOLDSBORO | ||||||||
| State: | NC | ||||||||
| PostalCode: | 275341789 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9195874400 | ||||||||
| FaxNumber: | 9195874411 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/12/2005 | ||||||||
| LastUpdateDate: | 09/08/2016 | ||||||||
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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 | 208200000X | 2009-00677 | NC | Y | Allopathic & Osteopathic Physicians | Plastic Surgery |
ID Information
| ID | Type | State | Issuer | Description | 5913214 | 05 | NC | MEDICAID |