Provider Demographics
NPI:1194841015
Name:ELDER, BENJAMIN B (MD)
Entity Type:Individual
Prefix:DR
First Name:BENJAMIN
Middle Name:B
Last Name:ELDER
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:PO BOX 3239
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:SC
Mailing Address - Zip Code:29502-3239
Mailing Address - Country:US
Mailing Address - Phone:843-777-5065
Mailing Address - Fax:843-777-7620
Practice Address - Street 1:204 E CHEVES ST
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:SC
Practice Address - Zip Code:29506-2604
Practice Address - Country:US
Practice Address - Phone:843-777-5065
Practice Address - Fax:843-777-7620
Is Sole Proprietor?:No
Enumeration Date:2007-03-22
Last Update Date:2021-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC29736208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics