Provider Demographics
NPI:1245201805
Name:VANDERZWAAG, BENJAMIN HENRY (MD)
Entity Type:Individual
Prefix:DR
First Name:BENJAMIN
Middle Name:HENRY
Last Name:VANDERZWAAG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:2365 WESTLAKE DR
Mailing Address - Street 2:
Mailing Address - City:KELSEYVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95451-7055
Mailing Address - Country:US
Mailing Address - Phone:707-279-2078
Mailing Address - Fax:707-279-0890
Practice Address - Street 1:575 LINCOLN
Practice Address - Street 2:SUITE 310
Practice Address - City:NAPA
Practice Address - State:CA
Practice Address - Zip Code:94558
Practice Address - Country:US
Practice Address - Phone:707-256-3800
Practice Address - Fax:707-256-3508
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAC337472085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA35372Medicare UPIN