Provider Demographics
NPI:1366961823
Name:BENCZKOWSKI, ELISE M (ND)
Entity type:Individual
Prefix:
First Name:ELISE
Middle Name:M
Last Name:BENCZKOWSKI
Suffix:
Gender:F
Credentials:ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5021 GREEN MOUNTAIN CIR UNIT 3
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21044-2439
Mailing Address - Country:US
Mailing Address - Phone:918-218-7320
Mailing Address - Fax:
Practice Address - Street 1:4801 DORSEY HALL DR STE 206
Practice Address - Street 2:
Practice Address - City:ELLICOTT CITY
Practice Address - State:MD
Practice Address - Zip Code:21042-7749
Practice Address - Country:US
Practice Address - Phone:918-218-7320
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-15
Last Update Date:2017-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDJ000034175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath