Provider Demographics
NPI:1366517153
Name:BENTSEN, BIRGER STEVEN (MD)
Entity type:Individual
Prefix:
First Name:BIRGER
Middle Name:STEVEN
Last Name:BENTSEN
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 1:10741 TREGO TRL
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27614-9660
Mailing Address - Country:US
Mailing Address - Phone:910-524-7100
Mailing Address - Fax:
Practice Address - Street 1:1908 MEETING CT
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28401-6631
Practice Address - Country:US
Practice Address - Phone:910-815-0260
Practice Address - Fax:910-763-3311
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-21
Last Update Date:2020-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC284612084A0401X, 2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084A0401XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyAddiction Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2326986OtherGROUP PIN
NC1790860971OtherGROUP NPI
NC8915073Medicaid
NC15073OtherBLUE CROSS NORTH CAROLINA
NC2022918OtherMEDICARE ID- TYPE UNSPECIFIED
NC8915073Medicaid