Provider Demographics
NPI:1720835457
Name:SHREVE, BENJAMIN FREDERICK III
Entity type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:FREDERICK
Last Name:SHREVE
Suffix:III
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 UPPER KANAWHA VALLEY WAY
Mailing Address - Street 2:
Mailing Address - City:CABIN CREEK
Mailing Address - State:WV
Mailing Address - Zip Code:25305
Mailing Address - Country:US
Mailing Address - Phone:304-533-2034
Mailing Address - Fax:
Practice Address - Street 1:200 UPPER KANAWHA VALLEY WAY
Practice Address - Street 2:
Practice Address - City:CABIN CREEK
Practice Address - State:WV
Practice Address - Zip Code:25305
Practice Address - Country:US
Practice Address - Phone:304-533-2034
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-01
Last Update Date:2024-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist