1356419246 NPI number — DR. BENJAMIN GUY WITHERS MD, MPH

Table of content: DR. BENJAMIN GUY WITHERS MD, MPH (NPI 1356419246)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1356419246 NPI number — DR. BENJAMIN GUY WITHERS MD, MPH

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WITHERS
Provider First Name:
BENJAMIN
Provider Middle Name:
GUY
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD, MPH
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1356419246
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/10/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8616 W BOULEVARD DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ALEXANDRIA
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
22308-2031
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
703-799-1311
Provider Business Mailing Address Fax Number:
703-806-3591

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9501 FARRELL RD
Provider Second Line Business Practice Location Address:
DEWITT HEALTH CARE NETWORK
Provider Business Practice Location Address City Name:
FORT BELVOIR
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
22060-5901
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
703-806-4586
Provider Business Practice Location Address Fax Number:
703-806-3591
Provider Enumeration Date:
12/01/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2083P0500X , with the licence number:  0101052172 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)