Provider Demographics
NPI:1871511485
Name:BENFIELD, EDWARD S II (MD)
Entity type:Individual
Prefix:
First Name:EDWARD
Middle Name:S
Last Name:BENFIELD
Suffix:II
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:PO BOX 601067
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-1067
Mailing Address - Country:US
Mailing Address - Phone:704-358-2744
Mailing Address - Fax:704-358-2945
Practice Address - Street 1:501 BILLINGSLEY RD
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28211-1009
Practice Address - Country:US
Practice Address - Phone:704-358-2744
Practice Address - Fax:704-358-2945
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2014-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC94007192084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCN19094Medicaid
NC14829OtherBCBS
NC1871511485Medicaid
NC8914829Medicaid
NC2209689CMedicare PIN
NC1871511485Medicaid
NC8914829Medicaid