Provider Demographics
NPI:1023388451
Name:SCAPA, BENJAMIN MARK (DPM)
Entity Type:Individual
Prefix:DR
First Name:BENJAMIN
Middle Name:MARK
Last Name:SCAPA
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8040 161ST AVE NE
Mailing Address - Street 2:SUITE 268
Mailing Address - City:REDMOND
Mailing Address - State:WA
Mailing Address - Zip Code:98052-3807
Mailing Address - Country:US
Mailing Address - Phone:425-802-1621
Mailing Address - Fax:
Practice Address - Street 1:8040 161ST AVE NE
Practice Address - Street 2:SUITE 268
Practice Address - City:REDMOND
Practice Address - State:WA
Practice Address - Zip Code:98052-3807
Practice Address - Country:US
Practice Address - Phone:425-802-1621
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-02
Last Update Date:2012-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH000104731835G0303X
WAPO00000251213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
No1835G0303XPharmacy Service ProvidersPharmacistGeriatric