Provider Demographics
NPI:1487309092
Name:BENU, BILAL BEN
Entity type:Individual
Prefix:
First Name:BILAL
Middle Name:BEN
Last Name:BENU
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4380 ROLLING HILL RD
Mailing Address - Street 2:
Mailing Address - City:RED HOUSE
Mailing Address - State:VA
Mailing Address - Zip Code:23963-6362
Mailing Address - Country:US
Mailing Address - Phone:540-998-3727
Mailing Address - Fax:
Practice Address - Street 1:4380 ROLLING HILL RD
Practice Address - Street 2:
Practice Address - City:RED HOUSE
Practice Address - State:VA
Practice Address - Zip Code:23963-6362
Practice Address - Country:US
Practice Address - Phone:540-998-3727
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-14
Last Update Date:2022-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC49267171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor