Provider Demographics
NPI:1336456391
Name:BITEMAN, BENJAMIN RYAN (MD)
Entity Type:Individual
Prefix:DR
First Name:BENJAMIN
Middle Name:RYAN
Last Name:BITEMAN
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 1:627 EASTLAND AVE SE
Mailing Address - Street 2:STE 302
Mailing Address - City:WARREN
Mailing Address - State:OH
Mailing Address - Zip Code:44484-4501
Mailing Address - Country:US
Mailing Address - Phone:330-841-4477
Mailing Address - Fax:330-841-4505
Practice Address - Street 1:627 EASTLAND AVE SE
Practice Address - Street 2:STE 302
Practice Address - City:WARREN
Practice Address - State:OH
Practice Address - Zip Code:44484-4501
Practice Address - Country:US
Practice Address - Phone:330-841-4477
Practice Address - Fax:330-841-4505
Is Sole Proprietor?:No
Enumeration Date:2010-09-10
Last Update Date:2017-01-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
OH35.124042208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0122553Medicaid