Provider Demographics
NPI:1427075183
Name:SY, BENJAMIN MARTIN C (MD)
Entity type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:MARTIN C
Last Name:SY
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 1:2512 WHEATON WAY
Mailing Address - Street 2:
Mailing Address - City:BREMERTON
Mailing Address - State:WA
Mailing Address - Zip Code:98310-3399
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2512 WHEATON WAY
Practice Address - Street 2:
Practice Address - City:BREMERTON
Practice Address - State:WA
Practice Address - Zip Code:98310-3399
Practice Address - Country:US
Practice Address - Phone:360-782-3700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2010-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0062889207RC0200X, 207RP1001X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA213846OtherLABOR & INDUSTRIES
WA8464745Medicaid
WA1423712OtherAETNA
P00392555OtherRAILROAD MEDICARE
WA2512SYOtherREGENCE BLUE SHIELD
WAG8862613Medicare PIN
WA213846OtherLABOR & INDUSTRIES
G8869551Medicare PIN
G8878999Medicare PIN
WA8464745Medicaid
WAG8862612Medicare PIN
G8895802Medicare PIN
WAG8862611Medicare PIN