Provider Demographics
NPI:1346551181
Name:KLEIFGEN, BENJAMIN
Entity Type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:
Last Name:KLEIFGEN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 WELLNESS WAY
Mailing Address - Street 2:BUILDING 2
Mailing Address - City:WASHINGTON
Mailing Address - State:PA
Mailing Address - Zip Code:15301-9706
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:100 WELLNESS WAY
Practice Address - Street 2:BUILDING 2
Practice Address - City:WASHINGTON
Practice Address - State:PA
Practice Address - Zip Code:15301-9706
Practice Address - Country:US
Practice Address - Phone:724-250-6001
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-06-26
Last Update Date:2021-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD4486332083P0011X, 208000000X
WV25337208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No2083P0011XAllopathic & Osteopathic PhysiciansPreventive MedicineUndersea and Hyperbaric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1028452500002Medicaid
WV3810026278Medicaid
OH0091753Medicaid