Provider Demographics
NPI:1073833042
Name:KAFFENBERGER, BENJAMIN HARRIS (MD)
Entity Type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:HARRIS
Last Name:KAFFENBERGER
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 1:700 ACKERMAN RD STE 2120
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43202-1559
Mailing Address - Country:US
Mailing Address - Phone:614-293-1707
Mailing Address - Fax:614-293-1716
Practice Address - Street 1:1328 DUBLIN RD STE 100
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43215-1054
Practice Address - Country:US
Practice Address - Phone:614-293-1707
Practice Address - Fax:614-293-1716
Is Sole Proprietor?:No
Enumeration Date:2010-06-01
Last Update Date:2021-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35123455207N00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program