Provider Demographics
NPI:1972529626
Name:REZBA, BENJAMIN V (MD)
Entity type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:V
Last Name:REZBA
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 1:1870 AMHERST ST
Mailing Address - Street 2:SUITE 2D
Mailing Address - City:WINCHESTER
Mailing Address - State:VA
Mailing Address - Zip Code:22601-2841
Mailing Address - Country:US
Mailing Address - Phone:540-536-8719
Mailing Address - Fax:540-536-8996
Practice Address - Street 1:1870 AMHERST ST
Practice Address - Street 2:SUITE 2D
Practice Address - City:WINCHESTER
Practice Address - State:VA
Practice Address - Zip Code:22601-2841
Practice Address - Country:US
Practice Address - Phone:540-536-8719
Practice Address - Fax:540-536-8996
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-14
Last Update Date:2009-04-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0101024115207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA006402631Medicaid
200040733OtherREILROAD MEDICARE
WV1804569000Medicaid
VA006402631Medicaid
200040733OtherREILROAD MEDICARE