Provider Demographics
NPI:1366980559
Name:AWO, BENEDICT (DO)
Entity type:Individual
Prefix:
First Name:BENEDICT
Middle Name:
Last Name:AWO
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5040 BRADENTON AVE STE A
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:OH
Mailing Address - Zip Code:43017-3524
Mailing Address - Country:US
Mailing Address - Phone:614-389-5452
Mailing Address - Fax:614-389-5399
Practice Address - Street 1:5040 BRADENTON AVE STE 3
Practice Address - Street 2:
Practice Address - City:DUBLIN
Practice Address - State:OH
Practice Address - Zip Code:43017-3522
Practice Address - Country:US
Practice Address - Phone:614-389-5452
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-07
Last Update Date:2025-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34.014569CTR207Q00000X
PAOT019239207Q00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program