Provider Demographics
NPI:1275523110
Name:LOCKSHIN, BENJAMIN NATHANIEL (MD)
Entity Type:Individual
Prefix:DR
First Name:BENJAMIN
Middle Name:NATHANIEL
Last Name:LOCKSHIN
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 1:10313 GEROGIA AVE
Mailing Address - Street 2:SUITE 309
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20902-5006
Mailing Address - Country:US
Mailing Address - Phone:301-681-7000
Mailing Address - Fax:301-681-1040
Practice Address - Street 1:10313 GEORGIA AVE
Practice Address - Street 2:SUITE 309
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20902-5006
Practice Address - Country:US
Practice Address - Phone:301-681-7000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-10-23
Last Update Date:2014-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0063751207N00000X
OH35-086442207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD133610ZAH4Medicare PIN
DC018622N43Medicare PIN
MD133610ZAH4Medicare PIN