Provider Demographics
NPI:1164450946
Name:OVERLEY, BENJAMIN D JR (DPM)
Entity Type:Individual
Prefix:DR
First Name:BENJAMIN
Middle Name:D
Last Name:OVERLEY
Suffix:JR
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 1:35 BILL FRIES DR BLDG L
Mailing Address - Street 2:
Mailing Address - City:HILTON HEAD ISLAND
Mailing Address - State:SC
Mailing Address - Zip Code:29926-2797
Mailing Address - Country:US
Mailing Address - Phone:843-895-2140
Mailing Address - Fax:484-961-8304
Practice Address - Street 1:35 BILL FRIES DR BLDG L
Practice Address - Street 2:
Practice Address - City:HILTON HEAD ISLAND
Practice Address - State:SC
Practice Address - Zip Code:29926-2797
Practice Address - Country:US
Practice Address - Phone:843-895-2140
Practice Address - Fax:484-961-8304
Is Sole Proprietor?:No
Enumeration Date:2006-06-29
Last Update Date:2022-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASC004381L213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA003883Medicare ID - Type Unspecified
PAU68709Medicare UPIN