Provider Demographics
NPI:1174515175
Name:BENZ, THOMAS BARTLEY (MD)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:BARTLEY
Last Name:BENZ
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 1:230 HOSPITAL PLZ
Mailing Address - Street 2:
Mailing Address - City:WESTON
Mailing Address - State:WV
Mailing Address - Zip Code:26452-8558
Mailing Address - Country:US
Mailing Address - Phone:304-269-8128
Mailing Address - Fax:304-269-8162
Practice Address - Street 1:230 HOSPITAL PLZ
Practice Address - Street 2:
Practice Address - City:WESTON
Practice Address - State:WV
Practice Address - Zip Code:26452-8558
Practice Address - Country:US
Practice Address - Phone:304-269-8128
Practice Address - Fax:304-269-8162
Is Sole Proprietor?:No
Enumeration Date:2005-08-17
Last Update Date:2016-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV27000208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV1174515175Medicaid
WVWV6725AMedicare PIN
C29223Medicare UPIN
AL158717Medicaid
DE1000016049Medicaid