Provider Demographics
NPI:1114345691
Name:PURVIS, BENJAMIN
Entity Type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:
Last Name:PURVIS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 OHIO RIVER BLVD
Mailing Address - Street 2:
Mailing Address - City:BADEN
Mailing Address - State:PA
Mailing Address - Zip Code:15005
Mailing Address - Country:US
Mailing Address - Phone:724-869-6002
Mailing Address - Fax:724-869-6005
Practice Address - Street 1:210 OHIO RIVER BLVD
Practice Address - Street 2:
Practice Address - City:BADEN
Practice Address - State:PA
Practice Address - Zip Code:15005-1914
Practice Address - Country:US
Practice Address - Phone:724-869-6002
Practice Address - Fax:724-869-6005
Is Sole Proprietor?:No
Enumeration Date:2014-04-02
Last Update Date:2014-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA056779363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical