Provider Demographics
NPI:1366497430
Name:BENZA, RAYMOND L (MD)
Entity type:Individual
Prefix:
First Name:RAYMOND
Middle Name:L
Last Name:BENZA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 GRESHAM DR
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23507-1904
Mailing Address - Country:US
Mailing Address - Phone:757-388-3934
Mailing Address - Fax:757-388-2957
Practice Address - Street 1:600 GRESHAM DR
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23507-1904
Practice Address - Country:US
Practice Address - Phone:757-388-3934
Practice Address - Fax:757-388-2957
Is Sole Proprietor?:No
Enumeration Date:2006-05-24
Last Update Date:2025-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY189292207RC0000X
VA0101285991207RC0000X
OH35.138337207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1021447640001Medicaid
OH2841518Medicaid
AL000085242Medicaid
WV3810012859Medicaid
PAP00629709Medicare PIN
AL000085242Medicaid
WV3810012859Medicaid
WV3810012859Medicaid