Provider Demographics
NPI:1417923467
Name:WHITE, BENJAMIN ANDREW (DO)
Entity Type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:ANDREW
Last Name:WHITE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:513 SUPERIOR ST
Mailing Address - Street 2:
Mailing Address - City:ROSSFORD
Mailing Address - State:OH
Mailing Address - Zip Code:43460-1246
Mailing Address - Country:US
Mailing Address - Phone:419-666-5202
Mailing Address - Fax:
Practice Address - Street 1:513 SUPERIOR ST
Practice Address - Street 2:
Practice Address - City:ROSSFORD
Practice Address - State:OH
Practice Address - Zip Code:43460-1246
Practice Address - Country:US
Practice Address - Phone:419-666-5202
Practice Address - Fax:419-666-7081
Is Sole Proprietor?:No
Enumeration Date:2006-02-28
Last Update Date:2012-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34007296207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2293905Medicaid
OH4122294Medicare PIN
H54419Medicare UPIN
OH2293905Medicaid