Basic Information
| Provider Information | |||||||||
| NPI: | 1992779144 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ENG | ||||||||
| FirstName: | BENJAMIN | ||||||||
| MiddleName: | PETER | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
| OtherOrganizationName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 936 | ||||||||
| Address2: | |||||||||
| City: | NORFOLK | ||||||||
| State: | VA | ||||||||
| PostalCode: | 235010936 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7574465955 | ||||||||
| FaxNumber: | 7574465196 | ||||||||
| Practice Location | |||||||||
| Address1: | 721 FAIRFAX AVE | ||||||||
| Address2: | |||||||||
| City: | NORFOLK | ||||||||
| State: | VA | ||||||||
| PostalCode: | 235072007 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7574465955 | ||||||||
| FaxNumber: | 7574465196 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/15/2006 | ||||||||
| LastUpdateDate: | 01/23/2009 | ||||||||
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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 | 207Q00000X | 0101032402 | VA | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 005612641 | 05 | VA | MEDICAID | 05563 | 01 | NC | BC/BS | OTHER | 081922 | 01 | VA | ANTHEM | OTHER | PAR | 01 | VA | USA MANAGED CARE | OTHER | -002 -003 | 01 | VA | TRICARE/CHAMPUS | OTHER | PAR | 01 | VA | AETNA | OTHER | 005624851 | 05 | VA | MEDICAID | PAR | 01 | VA | CORVEL/CORCARE | OTHER | 11092 | 01 | VA | SENTARA OPTIMA | OTHER | PAR | 01 | VA | CIGNA | OTHER | 225564 | 01 | VA | UHC/MAMSI | OTHER | 8905563 | 05 | NC | MEDICAID | PAR | 01 | VA | VA HEALTH NETWORK | OTHER | PAR | 01 | VA | FIRST HEALTH COMMERCIAL/SOUTHERN HEALTH/COVENTRY | OTHER | 2180428 | 01 | VA | UHC/MAMSI | OTHER | PAR | 01 | VA | VIRGINIA PREMIER HEALTH | OTHER | PAR | 01 | VA | MULTIPLAN | OTHER |