Provider Demographics
NPI:1215498837
Name:VERDOW, BENJAMIN C (MS, RDN, CSP)
Entity type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:C
Last Name:VERDOW
Suffix:
Gender:M
Credentials:MS, RDN, CSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PSC 415 BOX 4126
Mailing Address - Street 2:
Mailing Address - City:APO
Mailing Address - State:AE
Mailing Address - Zip Code:09114-0042
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:BUILDING 475
Practice Address - Street 2:
Practice Address - City:GRANFENWOEHR
Practice Address - State:GA
Practice Address - Zip Code:92655
Practice Address - Country:US
Practice Address - Phone:314-590-3019
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-27
Last Update Date:2025-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered