Provider Demographics
NPI:1427599091
Name:MCAVINEW, BENJAMIN (APRN)
Entity Type:Individual
Prefix:MR
First Name:BENJAMIN
Middle Name:
Last Name:MCAVINEW
Suffix:
Gender:M
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6781 VANBUREN RD
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:OH
Mailing Address - Zip Code:44216
Mailing Address - Country:US
Mailing Address - Phone:330-962-4443
Mailing Address - Fax:
Practice Address - Street 1:4580 STEPHENS CIR NW STE 202
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44718-3645
Practice Address - Country:US
Practice Address - Phone:330-597-2815
Practice Address - Fax:330-244-8839
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-16
Last Update Date:2021-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.020353363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily