Provider Demographics
NPI:1477262830
Name:ABERSOLD, BENJAMIN THOMAS (CNP)
Entity Type:Individual
Prefix:MR
First Name:BENJAMIN
Middle Name:THOMAS
Last Name:ABERSOLD
Suffix:
Gender:M
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1929 MASON DIXON HWY
Mailing Address - Street 2:
Mailing Address - City:MAIDSVILLE
Mailing Address - State:WV
Mailing Address - Zip Code:26541-8152
Mailing Address - Country:US
Mailing Address - Phone:304-879-5020
Mailing Address - Fax:304-879-4105
Practice Address - Street 1:1929 MASON DIXON HWY
Practice Address - Street 2:
Practice Address - City:MAIDSVILLE
Practice Address - State:WV
Practice Address - Zip Code:26541-8152
Practice Address - Country:US
Practice Address - Phone:304-879-5020
Practice Address - Fax:304-879-4105
Is Sole Proprietor?:No
Enumeration Date:2022-11-15
Last Update Date:2023-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV114663363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily