Provider Demographics
NPI:1548311970
Name:BENJAMIN, JOYCE SMITH (PA-C)
Entity type:Individual
Prefix:MRS
First Name:JOYCE
Middle Name:SMITH
Last Name:BENJAMIN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7507 OLD CHAPEL DR
Mailing Address - Street 2:
Mailing Address - City:BOWIE
Mailing Address - State:MD
Mailing Address - Zip Code:20715-6011
Mailing Address - Country:US
Mailing Address - Phone:301-805-8399
Mailing Address - Fax:301-805-9417
Practice Address - Street 1:7507 OLD CHAPEL DR
Practice Address - Street 2:
Practice Address - City:BOWIE
Practice Address - State:MD
Practice Address - Zip Code:20715-6011
Practice Address - Country:US
Practice Address - Phone:301-805-8399
Practice Address - Fax:301-805-9417
Is Sole Proprietor?:No
Enumeration Date:2007-01-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDC0001331363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDS46214Medicare UPIN