Provider Demographics
NPI:1003557307
Name:HERSCH, BENJAMIN CHARLES (PA)
Entity Type:Individual
Prefix:MR
First Name:BENJAMIN
Middle Name:CHARLES
Last Name:HERSCH
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:918 LINCOLN AVE
Mailing Address - Street 2:
Mailing Address - City:GLENWOOD SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:81601-3714
Mailing Address - Country:US
Mailing Address - Phone:970-366-9845
Mailing Address - Fax:
Practice Address - Street 1:19070 E SUNLIGHT WAY BLDG 1000
Practice Address - Street 2:
Practice Address - City:BUCKLEY AFB
Practice Address - State:CO
Practice Address - Zip Code:80011-9574
Practice Address - Country:US
Practice Address - Phone:970-366-9845
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-02
Last Update Date:2022-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171000000XOther Service ProvidersMilitary Health Care Provider