Provider Demographics
NPI:1215968490
Name:TROTTER, BENJAMIN R (MD)
Entity type:Individual
Prefix:DR
First Name:BENJAMIN
Middle Name:R
Last Name:TROTTER
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 1:18 HOSPITAL CENTER BLVD
Mailing Address - Street 2:
Mailing Address - City:HILTON HEAD ISLAND
Mailing Address - State:SC
Mailing Address - Zip Code:29926-2733
Mailing Address - Country:US
Mailing Address - Phone:843-681-9355
Mailing Address - Fax:843-842-9700
Practice Address - Street 1:18 HOSPITAL CENTER BLVD
Practice Address - Street 2:
Practice Address - City:HILTON HEAD ISLAND
Practice Address - State:SC
Practice Address - Zip Code:29926-2733
Practice Address - Country:US
Practice Address - Phone:843-681-9355
Practice Address - Fax:843-842-9700
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-05
Last Update Date:2012-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC9914207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC571105505OtherBLUE CROSS BLUE SHIELD
SC099146Medicaid
SC110212757OtherRAILROAD MEDICARE
SC099146Medicaid
SC110212757OtherRAILROAD MEDICARE