Provider Demographics
NPI:1306093372
Name:PHELPS, BENJAMIN RYAN (MD, MPH, CTROPMED)
Entity type:Individual
Prefix:DR
First Name:BENJAMIN
Middle Name:RYAN
Last Name:PHELPS
Suffix:
Gender:M
Credentials:MD, MPH, CTROPMED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1300 PENNSYLVANIA AVE NW
Mailing Address - Street 2:OFFICE OF HIV/AIDS, 5.10.43
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20004-3002
Mailing Address - Country:US
Mailing Address - Phone:202-316-3034
Mailing Address - Fax:
Practice Address - Street 1:1300 PENNSYLVANIA AVE NW
Practice Address - Street 2:OFFICE OF HIV/AIDS, 5.10.43
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20004-3002
Practice Address - Country:US
Practice Address - Phone:202-316-3034
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-08-21
Last Update Date:2013-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCMD038610208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics