Provider Demographics
NPI:1548673171
Name:BENJAMIN-ALLEN, SAMANTHA (DO/MBA)
Entity type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:
Last Name:BENJAMIN-ALLEN
Suffix:
Gender:F
Credentials:DO/MBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1603 SARATOGA CT
Mailing Address - Street 2:
Mailing Address - City:FT WASHINGTON
Mailing Address - State:MD
Mailing Address - Zip Code:20744-4186
Mailing Address - Country:US
Mailing Address - Phone:240-339-5377
Mailing Address - Fax:
Practice Address - Street 1:1603 SARATOGA CT
Practice Address - Street 2:
Practice Address - City:FT WASHINGTON
Practice Address - State:MD
Practice Address - Zip Code:20744-4186
Practice Address - Country:US
Practice Address - Phone:240-339-5377
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-11
Last Update Date:2022-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDP30072208100000X
MDH0090526208100000X
DCDO034956208100000X
VAFB6755992208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty