Provider Demographics
NPI:1124279492
Name:BENJAMIN A WHITE, DO., LLC
Entity type:Organization
Organization Name:BENJAMIN A WHITE, DO., LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BENJAMIN
Authorized Official - Middle Name:A
Authorized Official - Last Name:WHITE
Authorized Official - Suffix:
Authorized Official - Credentials:4196665202
Authorized Official - Phone:419-666-5202
Mailing Address - Street 1:513 SUPERIOR ST
Mailing Address - Street 2:
Mailing Address - City:ROSSFORD
Mailing Address - State:OH
Mailing Address - Zip Code:43460-1246
Mailing Address - Country:US
Mailing Address - Phone:419-666-5202
Mailing Address - Fax:419-666-7081
Practice Address - Street 1:513 SUPERIOR ST
Practice Address - Street 2:
Practice Address - City:ROSSFORD
Practice Address - State:OH
Practice Address - Zip Code:43460-1246
Practice Address - Country:US
Practice Address - Phone:419-666-5202
Practice Address - Fax:419-666-7081
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-06
Last Update Date:2008-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34.007296207VX0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2293905Medicaid
OHBE9340181Medicare PIN