Provider Demographics
NPI:1720667215
Name:CROOKSHANK, BENJAMIN JOSEPH (MD)
Entity type:Individual
Prefix:DR
First Name:BENJAMIN
Middle Name:JOSEPH
Last Name:CROOKSHANK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:MR
Other - First Name:BENJAMIN
Other - Middle Name:J
Other - Last Name:CROOKSHANK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:301 RIVERVIEW AVE STE 810
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23510-1065
Mailing Address - Country:US
Mailing Address - Phone:757-252-9150
Mailing Address - Fax:
Practice Address - Street 1:301 RIVERVIEW AVE STE 810
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23510-1065
Practice Address - Country:US
Practice Address - Phone:757-252-9150
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-03
Last Update Date:2024-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101282157207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine